Provider Demographics
NPI:1710990528
Name:SHANEYFELT, KAREN ANN (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:SHANEYFELT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1579 SANCHEZ ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-2329
Mailing Address - Country:US
Mailing Address - Phone:415-821-4148
Mailing Address - Fax:415-821-4004
Practice Address - Street 1:1579 SANCHEZ ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-2329
Practice Address - Country:US
Practice Address - Phone:415-821-4148
Practice Address - Fax:415-821-4004
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT107400OtherBLUE SHIELD
CAPT10740OtherBLUE CROSS
CAPT10740OtherBLUE CROSS