Provider Demographics
NPI:1235119231
Name:INSKEEP, SHANE MATTHEW (PT)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:MATTHEW
Last Name:INSKEEP
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9811 BLACK BEAR HOLW SE
Mailing Address - Street 2:
Mailing Address - City:WINNABOW
Mailing Address - State:NC
Mailing Address - Zip Code:28479-5142
Mailing Address - Country:US
Mailing Address - Phone:910-371-3244
Mailing Address - Fax:
Practice Address - Street 1:408 E COURT ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON CH
Practice Address - State:OH
Practice Address - Zip Code:43160
Practice Address - Country:US
Practice Address - Phone:740-335-4129
Practice Address - Fax:740-335-9625
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08939225100000X
NC12584225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2265801Medicaid
OHIN4035891Medicare ID - Type Unspecified