Healthcare Provider Details

I. General information

NPI: 1417016478
Provider Name (Legal Business Name): SHAWN PETERS R.R.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 BELL ST
AMARILLO TX
79109-4281
US

IV. Provider business mailing address

PO BOX 51317
AMARILLO TX
79159-1317
US

V. Phone/Fax

Practice location:
  • Phone: 806-356-0009
  • Fax: 806-467-0356
Mailing address:
  • Phone: 806-356-0009
  • Fax: 806-467-0356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number59304
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: