Provider Demographics
NPI:1982619656
Name:ETTINGER, SHAINA EILEEN (PT)
Entity Type:Individual
Prefix:MISS
First Name:SHAINA
Middle Name:EILEEN
Last Name:ETTINGER
Suffix:
Gender:F
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:PO BOX 3497
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-0300
Mailing Address - Country:US
Mailing Address - Phone:877-552-2996
Mailing Address - Fax:866-245-8064
Practice Address - Street 1:13203 N 103RD AVE
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3028
Practice Address - Country:US
Practice Address - Phone:866-933-4248
Practice Address - Fax:623-933-7049
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ106498Medicare ID - Type Unspecified
AZP00372813Medicare UPIN
AZP00372813Medicare PIN