Provider Demographics
NPI:1427028380
Name:VANDEHATERT, SHAWNDA R (PT)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNDA
Middle Name:R
Last Name:VANDEHATERT
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 1:3377 COMPTON RD
Mailing Address - Street 2:STE 140
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-2506
Mailing Address - Country:US
Mailing Address - Phone:513-245-0100
Mailing Address - Fax:513-245-2372
Practice Address - Street 1:3377 COMPTON RD
Practice Address - Street 2:STE 140
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-2506
Practice Address - Country:US
Practice Address - Phone:513-245-0100
Practice Address - Fax:513-245-2372
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08606225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHVA4170291Medicare ID - Type Unspecified