Provider Demographics
NPI:1609007541
Name:CLATTERBUCK, SHANE DOUGLAS (PT)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:DOUGLAS
Last Name:CLATTERBUCK
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 1:9376 E BAHIA DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1532
Mailing Address - Country:US
Mailing Address - Phone:480-556-8406
Mailing Address - Fax:480-607-5840
Practice Address - Street 1:9376 E BAHIA DR
Practice Address - Street 2:SUITE 103
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1532
Practice Address - Country:US
Practice Address - Phone:480-556-8406
Practice Address - Fax:480-607-5840
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist