Provider Demographics
NPI:1568431401
Name:TEIXEIRA, SHAN MARTIN (PT, MOMT, OCS)
Entity Type:Individual
Prefix:MR
First Name:SHAN
Middle Name:MARTIN
Last Name:TEIXEIRA
Suffix:
Gender:M
Credentials:PT, MOMT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 MAIN ST
Mailing Address - Street 2:SUTIE 1
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5945
Mailing Address - Country:US
Mailing Address - Phone:207-777-3002
Mailing Address - Fax:
Practice Address - Street 1:581 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5945
Practice Address - Country:US
Practice Address - Phone:207-777-3002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT23212251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic