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General NPI Number Information
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NPI Number | 1669010161
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Entity Type | Individual
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Provider Name | SHANTELLE ANOSIKE DPT
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Gender | Female
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Dates
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Enumeration Date | 12/15/2019
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 3645 N BEACH ST
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City | FORT WORTH
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State | TX
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Zip | 76137-3242
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Country | US
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Telephone | 803-409-9006
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Fax |
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Provider Business Mailing Address
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Address Line | 11325 PARK VISTA BLVD APT 2204
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City | FORT WORTH
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State | TX
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Zip | 76244-7160
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Country | US
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Telephone | 803-409-9006
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 294861
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 1344345
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License Number State | TX
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