Provider Demographics
NPI:1588189930
Name:SHAWKE, ANITA (PT)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:SHAWKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:BAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11960 WESTLINE INDUSTRIAL DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11960 WESTLINE INDUSTRIAL DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146
Practice Address - Country:US
Practice Address - Phone:314-439-1949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009006853225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist