Provider Demographics
NPI:1730498536
Name:STRATTON, SHAWN LOCKIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:LOCKIE
Last Name:STRATTON
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 1:1610 LUZA ST
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-1511
Mailing Address - Country:US
Mailing Address - Phone:979-255-6113
Mailing Address - Fax:
Practice Address - Street 1:1610 LUZA ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-1511
Practice Address - Country:US
Practice Address - Phone:979-255-6113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1096980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist