Provider Demographics
NPI:1275514002
Name:SEIBEL, SHAUN C (PT)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:C
Last Name:SEIBEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:TWISP
Mailing Address - State:WA
Mailing Address - Zip Code:98856-0327
Mailing Address - Country:US
Mailing Address - Phone:509-996-9241
Mailing Address - Fax:
Practice Address - Street 1:305 METHOW VALLEY HIGHWAY
Practice Address - Street 2:
Practice Address - City:TWISP
Practice Address - State:WA
Practice Address - Zip Code:98856
Practice Address - Country:US
Practice Address - Phone:509-997-4851
Practice Address - Fax:509-997-4852
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA025208 PT00005628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA33343OtherPERSONAL L&I ID
WA8335614Medicaid
WA8335614Medicaid