Provider Demographics
NPI:1114193323
Name:HIATT, SHAWN MONROE (MPT)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:MONROE
Last Name:HIATT
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6719 ALVARADO RD
Mailing Address - Street 2:#200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5270
Mailing Address - Country:US
Mailing Address - Phone:619-229-0375
Mailing Address - Fax:619-229-0305
Practice Address - Street 1:6719 ALVARADO RD
Practice Address - Street 2:#200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5270
Practice Address - Country:US
Practice Address - Phone:619-229-0375
Practice Address - Fax:619-229-0305
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34630225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist