Provider Demographics
NPI:1902804115
Name:SHAHAN, JOE DAVID (LPT)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:DAVID
Last Name:SHAHAN
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19325 US HIGHWAY 82
Mailing Address - Street 2:PO BOX 2072
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-6885
Mailing Address - Country:US
Mailing Address - Phone:903-892-1333
Mailing Address - Fax:903-893-9943
Practice Address - Street 1:19325 US HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-6885
Practice Address - Country:US
Practice Address - Phone:903-892-1333
Practice Address - Fax:903-893-9943
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX1018844225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00879EMedicare ID - Type Unspecified