Provider Demographics
NPI:1447509963
Name:THOMPSON, SHANNA LEANN
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:LEANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:LEANN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:5993 TOWER PL
Mailing Address - Street 2:
Mailing Address - City:JOINT BASE LEWIS MCCHORD
Mailing Address - State:WA
Mailing Address - Zip Code:98433-1101
Mailing Address - Country:US
Mailing Address - Phone:253-332-5162
Mailing Address - Fax:
Practice Address - Street 1:5993 TOWER PL
Practice Address - Street 2:
Practice Address - City:JOINT BASE LEWIS MCCHORD
Practice Address - State:WA
Practice Address - Zip Code:98433-1101
Practice Address - Country:US
Practice Address - Phone:253-332-5162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60240924225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist