Healthcare Provider Details

I. General information

NPI: 1235119231
Provider Name (Legal Business Name): SHANE MATTHEW INSKEEP PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 E COURT ST
WASHINGTON CH OH
43160
US

IV. Provider business mailing address

9811 BLACK BEAR HOLW SE
WINNABOW NC
28479-5142
US

V. Phone/Fax

Practice location:
  • Phone: 740-335-4129
  • Fax: 740-335-9625
Mailing address:
  • Phone: 910-371-3244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number08939
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12584
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: