Provider Demographics
NPI:1942538079
Name:ROFFMAN, SHAUNA JEAN (PT)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:JEAN
Last Name:ROFFMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:JEAN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:811 SANDY TRL
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-8477
Mailing Address - Country:US
Mailing Address - Phone:480-628-2180
Mailing Address - Fax:
Practice Address - Street 1:811 SANDY TRL
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-8477
Practice Address - Country:US
Practice Address - Phone:480-628-2180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1058477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist