Provider Demographics
NPI:1669010161
Name:ANOSIKE, SHANTELLE (DPT)
Entity Type:Individual
Prefix:DR
First Name:SHANTELLE
Middle Name:
Last Name:ANOSIKE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SHANTELLE
Other - Middle Name:
Other - Last Name:IGIOZEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11325 PARK VISTA BLVD APT 2204
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-7160
Mailing Address - Country:US
Mailing Address - Phone:803-409-9006
Mailing Address - Fax:
Practice Address - Street 1:3645 N BEACH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-3242
Practice Address - Country:US
Practice Address - Phone:803-409-9006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-15
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2948612251X0800X
TX13443452251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic