Provider Demographics
NPI:1558487256
Name:SHAKSHOBER, MARTA JOSEPHINE (PTA)
Entity Type:Individual
Prefix:MR
First Name:MARTA
Middle Name:JOSEPHINE
Last Name:SHAKSHOBER
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 1:310 MILLER RD STOP 60
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-4522
Mailing Address - Country:US
Mailing Address - Phone:518-851-7516
Mailing Address - Fax:
Practice Address - Street 1:169 VALENTINE RD
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-3042
Practice Address - Country:US
Practice Address - Phone:413-445-9768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3427225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant