Individual
LEWINFRED A SHACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MDIV., LMT
Contact information
Practice address
7622 POPLAR PIKE, GERMANTOWN, TN 38138-5941
(901) 633-6259
Mailing address
2809 KIRBY RD STE 116, PMB 121, MEMPHIS, TN 38119-8245
(901) 633-6259
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
4952
TN
Other
Enumeration date
01/18/2017
Last updated
05/03/2017
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