Provider Demographics
NPI:1518762038
Name:PERRY, SHANNON L (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:PERRY
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 WALLINGWOOD DR BLDG 1502
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6923
Mailing Address - Country:US
Mailing Address - Phone:512-350-9122
Mailing Address - Fax:
Practice Address - Street 1:2525 WALLINGWOOD DR BLDG 1502
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6923
Practice Address - Country:US
Practice Address - Phone:512-350-9122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT111987225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist