Individual
SHAWN D AXTEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT,CST-D
Contact information
Practice address
20360 EMPIRE AVE # B-9A, BEND, OR 97703-5709
(360) 607-7226
(541) 706-9330
Mailing address
PO BOX 444, BEND, OR 97709-0444
(360) 607-7226
(541) 706-9330
Taxonomy
Speciality
Code
Description
License number
State
2081P0010X
Pediatric Rehabilitation Medicine Physician
WAPT0000574
WA
261QP2000X
Physical Therapy Clinic/Center
Primary
01557
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00005748
WA PHYSICAL THERAPY LICENSING BOARD
WA
01
—
01557
OREGON PT LICENSING BOARD
OR
Enumeration date
01/10/2007
Last updated
06/19/2024
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