Provider Demographics
NPI:1689605636
Name:SHONKWILER, WILLIAM FREDERICK (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:FREDERICK
Last Name:SHONKWILER
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:PO BOX 3497
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-0300
Mailing Address - Country:US
Mailing Address - Phone:877-552-2996
Mailing Address - Fax:866-245-8064
Practice Address - Street 1:1311 N. BELT HWY
Practice Address - Street 2:SUITE A & B
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506
Practice Address - Country:US
Practice Address - Phone:816-279-7778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002011893225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO650024543OtherRR MEDICARE
MOP00600064OtherRAILROAD MEDICARE
MO10001688300OtherCOMMUNITY HEALTH PLAN
MO487421505Medicaid
MOP00600064OtherRAILROAD MEDICARE
P67468Medicare UPIN
MO487421505Medicaid