Provider Demographics
NPI:1780718221
Name:SHADOW MANAGEMENT SERVICES, INC.
Entity type:Organization
Organization Name:SHADOW MANAGEMENT SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:AUBREY
Authorized Official - Last Name:VONDUERING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-855-0100
Mailing Address - Street 1:45 PARKER STE C
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1656
Mailing Address - Country:US
Mailing Address - Phone:949-855-0100
Mailing Address - Fax:949-855-0134
Practice Address - Street 1:45 PARKER STE C
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-1656
Practice Address - Country:US
Practice Address - Phone:949-855-0100
Practice Address - Fax:949-855-0134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty