Provider Demographics
NPI:1760807853
Name:CALETKA, SHAUNA (PT)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:CALETKA
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 1:997 73RD STREET OCEAN
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-5102
Mailing Address - Country:US
Mailing Address - Phone:607-727-9025
Mailing Address - Fax:
Practice Address - Street 1:997 73RD STREET OCEAN
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-5102
Practice Address - Country:US
Practice Address - Phone:607-727-9025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41017225100000X
FL39194225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist