Provider Demographics
NPI:1346645090
Name:TROUTMAN, SHAWN ERIK (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:ERIK
Last Name:TROUTMAN
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 1:4055 PASO ORO VERDE
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-8913
Mailing Address - Country:US
Mailing Address - Phone:951-491-1156
Mailing Address - Fax:
Practice Address - Street 1:28780 SINGLE OAK DR STE 295
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5535
Practice Address - Country:US
Practice Address - Phone:951-506-0200
Practice Address - Fax:951-506-0205
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB225188Medicare PIN
CACA138345Medicare PIN