Provider Demographics
NPI:1174993794
Name:SHA ZEN MASSAGE LLC
Entity type:Organization
Organization Name:SHA ZEN MASSAGE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST - OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:NETTLES
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:517-599-0225
Mailing Address - Street 1:6134 MAPLEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9479
Mailing Address - Country:US
Mailing Address - Phone:517-599-0225
Mailing Address - Fax:
Practice Address - Street 1:4695 WASHTENAW AVE
Practice Address - Street 2:STUDIO 19
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1301
Practice Address - Country:US
Practice Address - Phone:517-599-0225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501003718225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty