Individual
MRS. SHAWNA MARIE PONTIOUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
Mailing address
6310 STONY BROOK DR, FORT WAYNE, IN 46835-2326
(260) 745-6273
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT21405160
IN
Other
Enumeration date
10/21/2021
Last updated
10/21/2021
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