Individual
MR. BRIAN C SHAK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.S.P.T.
Contact information
Practice address
318 TOWN CENTER BLVD, EASTON, PA 18040-8366
(610) 253-3300
Mailing address
150 CHASE HOLLOW DR, NAZARETH, PA 18064-8104
(610) 746-9432
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT013574L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01133301
CAPITAL BLUE CROSS PROVID
PA
01
—
1300887
BLUE SHILED PROVIDER ID
PA
01
—
7692221
AETNA PROVIDER ID
PA
01
—
P00028339
RR MEDICARE PROVIDER ID
PA
01
—
P2607186
OXFORD PROVIDER ID
PA
Enumeration date
04/12/2006
Last updated
07/08/2007
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