Provider Demographics
NPI:1245446525
Name:SHEARER, KENNETH L JR (PT)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:L
Last Name:SHEARER
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:10807 CROSSBOW ARROW CT
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-0086
Mailing Address - Country:US
Mailing Address - Phone:330-501-5997
Mailing Address - Fax:
Practice Address - Street 1:6200 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7624
Practice Address - Country:US
Practice Address - Phone:330-966-8920
Practice Address - Fax:330-966-8898
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12726132251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic