Provider Demographics
NPI:1124404132
Name:SHULA, CALEN (DPT)
Entity type:Individual
Prefix:
First Name:CALEN
Middle Name:
Last Name:SHULA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 S LAKE STEVENS RD
Mailing Address - Street 2:STE E
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-2060
Mailing Address - Country:US
Mailing Address - Phone:425-334-1122
Mailing Address - Fax:425-334-1188
Practice Address - Street 1:1819 S LAKE STEVENS RD
Practice Address - Street 2:STE E
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-2060
Practice Address - Country:US
Practice Address - Phone:425-334-1122
Practice Address - Fax:425-334-1188
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60548361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist