Provider Demographics
NPI:1477835213
Name:FINK, SHANE LEDREW (LPTA)
Entity Type:Individual
Prefix:MR
First Name:SHANE
Middle Name:LEDREW
Last Name:FINK
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13511 ROBBINS RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-8003
Mailing Address - Country:US
Mailing Address - Phone:479-530-3852
Mailing Address - Fax:
Practice Address - Street 1:1801 FOREST HILLS BLVD
Practice Address - Street 2:205
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715-3016
Practice Address - Country:US
Practice Address - Phone:479-855-9348
Practice Address - Fax:479-855-9358
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 2554225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant