Provider Demographics
NPI:1689468720
Name:SHIELDS, ANA VICTORIA (PT)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:VICTORIA
Last Name:SHIELDS
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:ANA VICTORIA
Other - Middle Name:
Other - Last Name:AMPONIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3115 SW 97TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-4139
Mailing Address - Country:US
Mailing Address - Phone:407-314-4832
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:407-314-4832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61222224225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist