Provider Demographics
NPI:1124148051
Name:ROBERTS, SHAYNA L (PT)
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHAYNA
Other - Middle Name:L
Other - Last Name:ALT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6914 HOLABIRD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-1747
Mailing Address - Country:US
Mailing Address - Phone:410-284-5441
Mailing Address - Fax:410-284-5442
Practice Address - Street 1:6914 HOLABIRD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222-1747
Practice Address - Country:US
Practice Address - Phone:410-284-5441
Practice Address - Fax:410-284-5442
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22109225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD201193079OtherTAX ID