Update this page – If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS.
Individual
SHONNA RENEE MOAK
Active
Individual
SHONNA RENEE MOAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00009905
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0207948
DEPT OF LABOR & INDUSTRY
WA
01
—
1598725798
GROUP NPI NUMBER
WA
01
—
8451783
MEDICAID ID NUMBER
WA
01
—
912117273
TAX ID
WA
Enumeration date
01/04/2007
Last updated
08/23/2013
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