Provider Demographics
NPI:1235506973
Name:WILNER, SHAYNA ALEXIS (DPT)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:ALEXIS
Last Name:WILNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SHAYNA
Other - Middle Name:ALEXIS
Other - Last Name:RICHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:9852 BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-1709
Mailing Address - Country:US
Mailing Address - Phone:916-362-7962
Mailing Address - Fax:951-506-3002
Practice Address - Street 1:9852 BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-1709
Practice Address - Country:US
Practice Address - Phone:916-362-7962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB240166Medicare PIN
CACA164611Medicare PIN
CACA164610Medicare PIN
CACA164612Medicare PIN