Provider Demographics
NPI:1114157823
Name:PHALEN, SHAYNA (MPT)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:
Last Name:PHALEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 ROAD 222
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:MT
Mailing Address - Zip Code:59339-9505
Mailing Address - Country:US
Mailing Address - Phone:406-584-7011
Mailing Address - Fax:
Practice Address - Street 1:605 SULLIVAN AVE
Practice Address - Street 2:
Practice Address - City:CIRCLE
Practice Address - State:MT
Practice Address - Zip Code:59215
Practice Address - Country:US
Practice Address - Phone:406-485-3381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1831225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist