Provider Demographics
NPI:1154745396
Name:CRESCENZO, SHAWNA (MSPT, OCS, CPI)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:CRESCENZO
Suffix:
Gender:F
Credentials:MSPT, OCS, CPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 CAMINO DEL MAR STE G
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2800
Mailing Address - Country:US
Mailing Address - Phone:858-792-1124
Mailing Address - Fax:858-792-7775
Practice Address - Street 1:910 CAMINO DEL MAR STE G
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2800
Practice Address - Country:US
Practice Address - Phone:858-792-1124
Practice Address - Fax:858-792-7775
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27880225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist