Provider Demographics
NPI:1568702249
Name:URBAN, SHANA E (DPT)
Entity Type:Individual
Prefix:DR
First Name:SHANA
Middle Name:E
Last Name:URBAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17071 VENTURA BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4130
Mailing Address - Country:US
Mailing Address - Phone:818-232-4884
Mailing Address - Fax:
Practice Address - Street 1:17071 VENTURA BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4130
Practice Address - Country:US
Practice Address - Phone:818-232-4884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT39854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist