Provider Demographics
NPI:1508190513
Name:TRUMBOWER, SHAUN BRIAN (PTA)
Entity Type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:BRIAN
Last Name:TRUMBOWER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 BROADWAY RD
Mailing Address - Street 2:
Mailing Address - City:SWEET VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18656-2326
Mailing Address - Country:US
Mailing Address - Phone:570-256-4487
Mailing Address - Fax:
Practice Address - Street 1:128 BROADWAY RD
Practice Address - Street 2:
Practice Address - City:SWEET VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18656-2326
Practice Address - Country:US
Practice Address - Phone:570-256-4487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1000361225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant