Provider Demographics
NPI:1407561798
Name:SHANEYFELT, DEBORAH (PT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:SHANEYFELT
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 1:2371 IRONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6508
Mailing Address - Country:US
Mailing Address - Phone:541-359-8312
Mailing Address - Fax:
Practice Address - Street 1:6135 E ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-7023
Practice Address - Country:US
Practice Address - Phone:458-215-3803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist