Provider Demographics
NPI:1538476890
Name:SHANKLE, ANN MARIE (CERTIFIED ROLFER)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:SHANKLE
Suffix:
Gender:F
Credentials:CERTIFIED ROLFER
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:KEITH
Other - Last Name:SHANKLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:NAKNEK
Mailing Address - State:AK
Mailing Address - Zip Code:99633-0316
Mailing Address - Country:US
Mailing Address - Phone:907-246-7003
Mailing Address - Fax:
Practice Address - Street 1:316 LAKEVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:NAKNEK
Practice Address - State:AK
Practice Address - Zip Code:99633-0316
Practice Address - Country:US
Practice Address - Phone:907-246-7003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK937169225400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner