Provider Demographics
NPI:1306963954
Name:FRIEDE, SHAWN (PT)
Entity type:Individual
Prefix:MS
First Name:SHAWN
Middle Name:
Last Name:FRIEDE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1N878 KILLARNEY CT
Mailing Address - Street 2:
Mailing Address - City:ELBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60119-9128
Mailing Address - Country:US
Mailing Address - Phone:260-402-0872
Mailing Address - Fax:
Practice Address - Street 1:501 W FABYAN PKWY
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1267
Practice Address - Country:US
Practice Address - Phone:630-524-2445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006553A225100000X
IL070.019008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000480307OtherANTHEM