Provider Demographics
NPI:1437362126
Name:COBURN, SHAWNEE G (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNEE
Middle Name:G
Last Name:COBURN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10525 E SWAN RD
Mailing Address - Street 2:
Mailing Address - City:LAOTTO
Mailing Address - State:IN
Mailing Address - Zip Code:46763
Mailing Address - Country:US
Mailing Address - Phone:260-897-2471
Mailing Address - Fax:
Practice Address - Street 1:215 DAVIS RD
Practice Address - Street 2:
Practice Address - City:OSSIAN
Practice Address - State:IN
Practice Address - Zip Code:46777
Practice Address - Country:US
Practice Address - Phone:260-622-7821
Practice Address - Fax:260-622-4370
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002714A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant