Provider Demographics
NPI:1871905471
Name:MCCONATHY, SHAWN (LMT CMT)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:MCCONATHY
Suffix:
Gender:F
Credentials:LMT CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MCDONALD ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-5664
Mailing Address - Country:US
Mailing Address - Phone:864-430-3928
Mailing Address - Fax:
Practice Address - Street 1:319 WADE HAMPTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-5738
Practice Address - Country:US
Practice Address - Phone:864-365-6156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-30
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT009659171W00000X, 225700000X
SCMAS 9765225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171W00000XOther Service ProvidersContractor