Individual
KELLIE SHANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3440 CONWAY BLVD, 3B, PORT CHARLOTTE, FL 33952-7000
(941) 766-1882
Mailing address
3440 CONWAY BLVD, 3B, PORT CHARLOTTE, FL 33952-7000
(941) 766-1882
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA73679
FL
Other
Enumeration date
03/14/2014
Last updated
03/14/2014
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