Provider Demographics
NPI:1073747200
Name:SHANK, JOHN W (EDD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:SHANK
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2406
Mailing Address - Country:US
Mailing Address - Phone:610-896-5897
Mailing Address - Fax:
Practice Address - Street 1:1413 HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-2406
Practice Address - Country:US
Practice Address - Phone:610-896-5897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist