Basic Information
Provider Information
NPI: 1205222973
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SLOAN
FirstName: SHANA
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: PTA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2021 N FM 1417
Address2:  
City: SHERMAN
State: TX
PostalCode: 750923106
CountryCode: US
TelephoneNumber: 9038924800
FaxNumber: 9038924444
Practice Location
Address1: 2021 N FM 1417
Address2:  
City: SHERMAN
State: TX
PostalCode: 750923106
CountryCode: US
TelephoneNumber: 9038924800
FaxNumber: 9038924444
Other Information
ProviderEnumerationDate: 04/09/2015
LastUpdateDate: 04/09/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225200000X2099981TXY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant 

No ID Information.


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