Provider Demographics
NPI:1881792000
Name:SHEKLOW, SANFORD (PT)
Entity type:Individual
Prefix:
First Name:SANFORD
Middle Name:
Last Name:SHEKLOW
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 MARKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1137
Mailing Address - Country:US
Mailing Address - Phone:818-790-3001
Mailing Address - Fax:818-790-9732
Practice Address - Street 1:1346 FOOTHILL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-2122
Practice Address - Country:US
Practice Address - Phone:818-790-3001
Practice Address - Fax:818-790-9732
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14276225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT14276AMedicare ID - Type Unspecified