Provider Demographics
NPI:1164643698
Name:DUNCAN, SHAWN S (LMT)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:S
Last Name:DUNCAN
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 1:2510 COMMONS BLVD.
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431
Mailing Address - Country:US
Mailing Address - Phone:937-429-8620
Mailing Address - Fax:937-429-8629
Practice Address - Street 1:2510 COMMONS BLVD.
Practice Address - Street 2:SUITE 240
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431
Practice Address - Country:US
Practice Address - Phone:937-429-8620
Practice Address - Fax:937-429-8629
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.014409225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist