Provider Demographics
NPI:1598946634
Name:SPANIHEL, SHAWN KEVIN (PT)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:KEVIN
Last Name:SPANIHEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N HWY 77
Mailing Address - Street 2:SUITE N
Mailing Address - City:RAYMONDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78580-4010
Mailing Address - Country:US
Mailing Address - Phone:956-689-9195
Mailing Address - Fax:956-689-9217
Practice Address - Street 1:100 N HWY 77
Practice Address - Street 2:SUITE N
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-4010
Practice Address - Country:US
Practice Address - Phone:956-689-9195
Practice Address - Fax:956-689-9217
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX659445OtherBLUE CROSS/BLUE SHIELD