Provider Demographics
NPI:1861797714
Name:HASTINGS, SHAE D'ANNA (PT)
Entity type:Individual
Prefix:MRS
First Name:SHAE
Middle Name:D'ANNA
Last Name:HASTINGS
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 1:400 W 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-4140
Mailing Address - Country:US
Mailing Address - Phone:806-337-5016
Mailing Address - Fax:806-337-5015
Practice Address - Street 1:400 W 14TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-4140
Practice Address - Country:US
Practice Address - Phone:806-337-5016
Practice Address - Fax:806-337-5015
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1195793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist