Provider Demographics
NPI:1326936634
Name:SHACKELFORD, JULIA ELIZABETH (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ELIZABETH
Last Name:SHACKELFORD
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 WATERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28339-8668
Mailing Address - Country:US
Mailing Address - Phone:910-890-4950
Mailing Address - Fax:
Practice Address - Street 1:6791 OVERHILLS RD
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-8873
Practice Address - Country:US
Practice Address - Phone:910-704-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21674225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist