Provider Demographics
NPI:1164921458
Name:CARTER, SHANA LYNN (DPT)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:LYNN
Last Name:CARTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:LYNN
Other - Last Name:KENDRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:136 SOTIR ST NW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4355
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:136 SOTIR ST NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4355
Practice Address - Country:US
Practice Address - Phone:850-797-6484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33288225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT33288OtherPHYSICAL THERAPY LICENSE