Provider Demographics
NPI:1669744744
Name:SHINN-EVINGER, LOUANN (PTA)
Entity type:Individual
Prefix:
First Name:LOUANN
Middle Name:
Last Name:SHINN-EVINGER
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 1:13830 58TH STREET NORTH
Mailing Address - Street 2:SUITE 409
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3720
Mailing Address - Country:US
Mailing Address - Phone:727-532-1900
Mailing Address - Fax:727-532-4300
Practice Address - Street 1:13830 58TH STREET NORTH
Practice Address - Street 2:SUITE 409
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3720
Practice Address - Country:US
Practice Address - Phone:727-532-1900
Practice Address - Fax:727-532-4300
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 1158208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA 1158OtherPHYSICAL THERAPY