Provider Demographics
NPI:1356673289
Name:CHANEY, SHANE (MPT)
Entity Type:Individual
Prefix:MR
First Name:SHANE
Middle Name:
Last Name:CHANEY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 STANWELL DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-4862
Mailing Address - Country:US
Mailing Address - Phone:925-686-5400
Mailing Address - Fax:925-686-3709
Practice Address - Street 1:2600 STANWELL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4862
Practice Address - Country:US
Practice Address - Phone:925-686-5400
Practice Address - Fax:925-686-3709
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26603ZMedicare PIN