Shane Marlon Pederson, P.T.
Individual provider Active NPI Physical Therapist · Palmhurst, TX
NPI 1003066853 · NPPES record last updated Jul 24, 2013
Key facts
- NPI
- 1003066853
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 1155757 (TX)
- Practice address
- 123 West Mile 3 Road
Suite a-103
Palmhurst, TX 78573 - Phone
- (956) 585-9889
- Fax
- (956) 585-9896
- NPI assigned
- Sep 29, 2008
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1155757 | TX | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1155757 | TX | Yes |
Addresses
Primary practice location
123 West Mile 3 Road
Suite a-103
Palmhurst, TX 78573
Mailing address
123 West Mile 3 Road
Suite a-103
Palmhurst, TX 78573
Phone (956) 585-9889
Other providers in Palmhurst, TX
- North Conway Family Dentistry, PLLC
- Ops Rehabilitation
- Palmhurst Dental and Orthodontics PLLC
- Pederson-Martinez PLLC
- Jessica Elizabeth Pederson
- Pediatric Kids Land Clinic P.a.
- Helen Pena
- Crystal Perez
- Sylvia Quinones
- Marcela Ramirez
All providers in Palmhurst, TX · Physical Therapist in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.