Provider Demographics
NPI:1609753383
Name:SHAW, MICHAEL NELSON (LMT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:NELSON
Last Name:SHAW
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9171 SIR CHARLES CT
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:TN
Mailing Address - Zip Code:37341-3102
Mailing Address - Country:US
Mailing Address - Phone:228-348-0009
Mailing Address - Fax:228-348-0009
Practice Address - Street 1:225 2ND ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-5014
Practice Address - Country:US
Practice Address - Phone:228-348-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-16
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14034225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist