Provider Demographics
NPI:1588895031
Name:SHIKANY, ANITA A (PT, GCS)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:A
Last Name:SHIKANY
Suffix:
Gender:F
Credentials:PT, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3151 E SOUTHERNVIEW RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-6200
Mailing Address - Country:US
Mailing Address - Phone:417-818-4693
Mailing Address - Fax:
Practice Address - Street 1:3550 S NATIONAL AVE STE 200
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7333
Practice Address - Country:US
Practice Address - Phone:417-269-9330
Practice Address - Fax:417-269-0582
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO022122251G0304X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1225113640OtherMEDICAID, MEDICARE, ALL COMMERCIAL INSURANCE