Provider Demographics
NPI:1366212409
Name:WOOD, SHAWN CAITLIN (DPT)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:CAITLIN
Last Name:WOOD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 ZURICH LN
Mailing Address - Street 2:
Mailing Address - City:INCLINE VILLAGE
Mailing Address - State:NV
Mailing Address - Zip Code:89451-7906
Mailing Address - Country:US
Mailing Address - Phone:775-846-5851
Mailing Address - Fax:
Practice Address - Street 1:10775 PIONEER TRL STE 108
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0233
Practice Address - Country:US
Practice Address - Phone:775-846-5851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4939225100000X
CA305013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist