Mr. Shane Marlon Pederson
Physical Therapist
123 West Mile 3 Road Suite A-103
Palmhurst
, Texas 78573
Mr. Shane Marlon Pederson
Physical Therapist
123 West Mile 3 Road Suite A-103
Palmhurst
, Texas 78573
(956) 585-9896
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About
Features
Specialties
- Physical Therapist
Languages spoken
- English
Location
First Address
- Mr. Shane Marlon Pederson
- 123 West Mile 3 Road Suite A-103
- Palmhurst, TX
- Zip : 78573
- Fax : (956) 585-9896
- Phone : (956) 585-9889
Second Address
- Mr. Shane Marlon Pederson
- 123 West Mile 3 Road Suite A-103
- Palmhurst, TX
- Zip : 78573
- Fax : (956) 585-9896
- Phone : (956) 585-9889
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Is Mr. Shane Marlon Pederson a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 225100000X | Physical Therapist | 1155757 | TX |
National Provider Identifier
| NPI | 1003066853 |
|---|---|
| Provider Name | Mr. Shane Marlon Pederson |
| First Address | Palmhurst, TX 78573 |
| Second Address | Palmhurst, TX 78573 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 29/09/2008 |
| Last Update Date | 24/07/2013 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.