Provider Demographics
NPI:1922711514
Name:BOEHM, SHAINA ELIZABETH
Entity Type:Individual
Prefix:
First Name:SHAINA
Middle Name:ELIZABETH
Last Name:BOEHM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 COUNTY ROAD 635
Mailing Address - Street 2:
Mailing Address - City:FREEBURG
Mailing Address - State:MO
Mailing Address - Zip Code:65035-2525
Mailing Address - Country:US
Mailing Address - Phone:573-694-6605
Mailing Address - Fax:
Practice Address - Street 1:3600 COUNTRY CLUB DR STE 530B
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-1060
Practice Address - Country:US
Practice Address - Phone:573-606-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist