Provider Demographics
NPI:1548681257
Name:SARVER, SHAUNA M (PTA23919)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:M
Last Name:SARVER
Suffix:
Gender:F
Credentials:PTA23919
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2679 N FOREST RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442-5123
Mailing Address - Country:US
Mailing Address - Phone:352-746-2371
Mailing Address - Fax:352-746-3729
Practice Address - Street 1:2679 N FOREST RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442-5123
Practice Address - Country:US
Practice Address - Phone:352-746-2371
Practice Address - Fax:352-746-3729
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA23919225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant