Provider Demographics
NPI:1689480097
Name:SHREEVE, JAMES (LMT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:SHREEVE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 E BASELINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2467
Mailing Address - Country:US
Mailing Address - Phone:480-304-5152
Mailing Address - Fax:
Practice Address - Street 1:2451 E BASELINE RD STE 100
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2467
Practice Address - Country:US
Practice Address - Phone:480-304-5152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-30415225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist