Provider Demographics
NPI:1073826749
Name:ALLRED, SHANA G (DPT)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:G
Last Name:ALLRED
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:G
Other - Last Name:MULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:16125 JUANITA WOODINVILLE WAY NE UNIT 2502
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-9433
Mailing Address - Country:US
Mailing Address - Phone:206-849-1618
Mailing Address - Fax:425-646-3901
Practice Address - Street 1:16125 JUANITA WOODINVILLE WAY NE UNIT 2502
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-9433
Practice Address - Country:US
Practice Address - Phone:206-849-1618
Practice Address - Fax:425-646-3901
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60173504225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8895425Medicare PIN
WAG8905391Medicare PIN