Healthcare Provider Details

I. General information

NPI: 1194340281
Provider Name (Legal Business Name): SHAWNA TROMBLEY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAWNA CARBONE

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 N LIMA RD
KENDALLVILLE IN
46755-1155
US

IV. Provider business mailing address

4251 LAHMEYER RD
FORT WAYNE IN
46815-5676
US

V. Phone/Fax

Practice location:
  • Phone: 260-242-5345
  • Fax:
Mailing address:
  • Phone: 260-432-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05013741A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: