Provider Demographics
NPI:1548005580
Name:ISAAC, SHANEQUA (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:SHANEQUA
Middle Name:
Last Name:ISAAC
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 1:1605 NEEDMORE RD APT 204
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-2228
Mailing Address - Country:US
Mailing Address - Phone:662-275-3588
Mailing Address - Fax:
Practice Address - Street 1:882 KRAFT ST STE E
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3062
Practice Address - Country:US
Practice Address - Phone:662-275-3588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14633225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist