Provider Demographics
NPI:1235577487
Name:FIFE, SHAWN (DPT)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:FIFE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4280 MERIDIAN ST STE 120
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-6464
Mailing Address - Country:US
Mailing Address - Phone:360-734-4300
Mailing Address - Fax:360-734-2128
Practice Address - Street 1:4280 MERIDIAN ST STE 120
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6464
Practice Address - Country:US
Practice Address - Phone:360-734-4300
Practice Address - Fax:360-734-2128
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60279319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist