Provider Demographics
NPI:1194995340
Name:MENKE, SHAUNDA L (DPT)
Entity type:Individual
Prefix:
First Name:SHAUNDA
Middle Name:L
Last Name:MENKE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4008 MENDENHALL OAKS PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8302
Mailing Address - Country:US
Mailing Address - Phone:366-976-1503
Mailing Address - Fax:
Practice Address - Street 1:4008 MENDENHALL OAKS PKWY STE 101
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8302
Practice Address - Country:US
Practice Address - Phone:366-976-1503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI137225100000X
NC10939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist