Provider Demographics
NPI:1619102621
Name:MOEHRING, SHAWN GLENN (MPT, DIP MDT, OCS)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:GLENN
Last Name:MOEHRING
Suffix:
Gender:M
Credentials:MPT, DIP MDT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 N THORNTON ST
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7495
Mailing Address - Country:US
Mailing Address - Phone:208-773-2888
Mailing Address - Fax:208-806-0222
Practice Address - Street 1:640 N THORNTON ST
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7495
Practice Address - Country:US
Practice Address - Phone:208-773-2888
Practice Address - Fax:208-806-0222
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-1075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDPT-1075OtherPHYSICAL THERAPY LICENSE