Provider Demographics
NPI:1255836086
Name:MASKALICK, SHAWN PHILLIP (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:PHILLIP
Last Name:MASKALICK
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 JOHN AUSTIN LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-6355
Mailing Address - Country:US
Mailing Address - Phone:502-428-7573
Mailing Address - Fax:
Practice Address - Street 1:4813 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40071-9739
Practice Address - Country:US
Practice Address - Phone:502-477-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-25
Last Update Date:2018-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0068992251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic