Provider Demographics
NPI:1730129115
Name:MCEWEN, SHAWN W (MPT)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:W
Last Name:MCEWEN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9315 GRAVELLY LAKE DR SW
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1574
Mailing Address - Country:US
Mailing Address - Phone:253-581-5200
Mailing Address - Fax:253-581-5203
Practice Address - Street 1:17520 MERIDIAN E
Practice Address - Street 2:SUITE F
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6265
Practice Address - Country:US
Practice Address - Phone:253-864-7595
Practice Address - Fax:253-864-0457
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8346967Medicaid
WAMC5342OtherREGENCE BLUESHEILD
WA124028OtherLABOR & INDUSTRIES
WA8930579OtherL&I CRIME VICTIMS PRGM
WAMC5342OtherREGENCE BLUESHEILD