1700324241 NPI number — MRS. SHANNON RUBENSTEIN KAPLAN PT, DPT, ATC

Table of content: MRS. SHANNON RUBENSTEIN KAPLAN PT, DPT, ATC (NPI 1700324241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700324241 NPI number — MRS. SHANNON RUBENSTEIN KAPLAN PT, DPT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAPLAN
Provider First Name:
SHANNON
Provider Middle Name:
RUBENSTEIN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700324241
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8020 ANGLE PARK DR
Provider Second Line Business Mailing Address:
APT 306
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27617-1890
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-577-5525
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2121 E WILLIAMS ST
Provider Second Line Business Practice Location Address:
SUITE #108
Provider Business Practice Location Address City Name:
APEX
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27539-7764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-372-8412
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  P16918 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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