Provider Demographics
NPI:1801227434
Name:BARNES, SHANE
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:BARNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 E HALLANDALE BEACH BLVD STE 605
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4638
Mailing Address - Country:US
Mailing Address - Phone:954-456-8900
Mailing Address - Fax:855-407-8201
Practice Address - Street 1:1250 E HALLANDALE BEACH BLVD STE 605
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4638
Practice Address - Country:US
Practice Address - Phone:954-456-8900
Practice Address - Fax:855-407-8201
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-08
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32468225100000X
KYPT006353225100000X
PAPT022870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist