Individual
SHANE MICHAEL NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
413 WOODFIELD DR, PIEDMONT, SC 29673-8373
(864) 209-0818
Mailing address
413 WOODFIELD DR, PIEDMONT, SC 29673-8373
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS6659
SC
Other
Enumeration date
11/08/2011
Last updated
11/08/2011
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