Provider Demographics
NPI:1437447125
Name:SPADE, SHAUN DAVID (PT)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:DAVID
Last Name:SPADE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 W 27TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-4975
Mailing Address - Country:US
Mailing Address - Phone:440-466-5447
Mailing Address - Fax:440-466-5455
Practice Address - Street 1:1822 S BROADWAY
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-7129
Practice Address - Country:US
Practice Address - Phone:440-466-5447
Practice Address - Fax:440-466-5455
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.011832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist