Provider Demographics
NPI:1265933204
Name:APENA, SHAKIRAH BOLANLE (PTA)
Entity type:Individual
Prefix:
First Name:SHAKIRAH
Middle Name:BOLANLE
Last Name:APENA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15423 HOPE SHADOW CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-6237
Mailing Address - Country:US
Mailing Address - Phone:757-777-1861
Mailing Address - Fax:
Practice Address - Street 1:15423 HOPE SHADOW CT
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-6237
Practice Address - Country:US
Practice Address - Phone:757-777-1861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2129516225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty