Provider Demographics
NPI:1972556850
Name:VONBERGEN, SHEILA MOH-SHUN (MPT)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:MOH-SHUN
Last Name:VONBERGEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:MOH-SHUN
Other - Last Name:SAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:27500 102ND AVE NW
Mailing Address - Street 2:STE 1
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-8092
Mailing Address - Country:US
Mailing Address - Phone:360-629-9768
Mailing Address - Fax:360-629-6487
Practice Address - Street 1:27500 102ND AVE NW
Practice Address - Street 2:STE 1
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-8092
Practice Address - Country:US
Practice Address - Phone:360-629-9768
Practice Address - Fax:360-629-6487
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G8860406Medicare PIN