Shelby Wallace, LMP

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA61147629 Issued in WA

Practice address

919 Highland Ave
Clarkston, WA 99403-2762

Phone

(509) 758-9214

NPI assigned

Mar 17, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Charles C Dwyer DC PC

  • Radiology Chiropractor
  • Clarkston, WA
  • NPI 1114168002
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1386229672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 HIGHLAND AVE",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032762",
            "telephone_number": "509-758-9214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 HIGHLAND AVE",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032762",
            "telephone_number": "509-758-9214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SHELBY",
        "credential": "LMP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-17",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA61147629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Wade
• Brent Wesley Wahlberg Jr., RPT
• Wal-Mart Stores, Inc.
• Ronny Alan Walden
• Walgreen Co
• Raymond A Waller, DDS
• Walmart Inc.
• Walter Williams
• Anne Heidi Wantz
• Warren L Ellison, M.D.

• Massage Therapist in Clarkston, WA
• Providers in Clarkston, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.