Provider Demographics
NPI:1578197711
Name:CLOUD, SHAWN L
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:L
Last Name:CLOUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LANDAN
Other - Middle Name:
Other - Last Name:CLOUD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3690 W WHEATLAND RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3462
Mailing Address - Country:US
Mailing Address - Phone:972-296-6645
Mailing Address - Fax:972-296-4526
Practice Address - Street 1:3690 W WHEATLAND RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3462
Practice Address - Country:US
Practice Address - Phone:972-296-6645
Practice Address - Fax:972-296-4526
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1323595225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist