Provider Demographics
NPI:1871543827
Name:BURNS, SHAUNA MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:SHAUNA
Middle Name:MARIE
Last Name:BURNS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:SHAUNA
Other - Middle Name:MARIE
Other - Last Name:BOILEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:824 175TH ST
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-2722
Mailing Address - Country:US
Mailing Address - Phone:219-937-6536
Mailing Address - Fax:
Practice Address - Street 1:3391 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-5105
Practice Address - Country:US
Practice Address - Phone:219-762-0821
Practice Address - Fax:219-763-3637
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007311A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist