Individual
SHELLY ANN PRIDEAUX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
1024 72ND ST E, TACOMA, WA 98404-1732
(253) 778-3459
Mailing address
1024 72ND ST E, TACOMA, WA 98404-1732
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
60179149
WA
Other
Enumeration date
10/19/2010
Last updated
05/25/2011
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