Provider Demographics
NPI:1144364183
Name:SHAVENDER, KIMBERLY MCCAMMON (DPT)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:MCCAMMON
Last Name:SHAVENDER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 NW 58TH ST
Mailing Address - Street 2:APT B
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-2030
Mailing Address - Country:US
Mailing Address - Phone:206-979-8856
Mailing Address - Fax:
Practice Address - Street 1:205 NW 58TH ST
Practice Address - Street 2:APT B
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-2030
Practice Address - Country:US
Practice Address - Phone:206-979-8856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010242225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist