Provider Demographics
NPI:1548946791
Name:SHIH, MAXINE (PT)
Entity type:Individual
Prefix:
First Name:MAXINE
Middle Name:
Last Name:SHIH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9924 NE 185TH ST APT 426
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3509
Mailing Address - Country:US
Mailing Address - Phone:626-658-6465
Mailing Address - Fax:
Practice Address - Street 1:18404 102ND AVE NE STE A
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3380
Practice Address - Country:US
Practice Address - Phone:425-486-6079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61420487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist