Provider Demographics
NPI:1811492804
Name:SHOOK, AMBER (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:
Last Name:SHOOK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 W WHITE OAK TER
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3674
Mailing Address - Country:US
Mailing Address - Phone:936-494-1211
Mailing Address - Fax:936-494-1215
Practice Address - Street 1:1803 W WHITE OAK TER
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3674
Practice Address - Country:US
Practice Address - Phone:936-494-1211
Practice Address - Fax:936-494-1215
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1301946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist