Provider Demographics
NPI:1053593152
Name:STRATFORD, SHANA REY (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:SHANA
Middle Name:REY
Last Name:STRATFORD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 NE 45TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5640
Mailing Address - Country:US
Mailing Address - Phone:206-402-5483
Mailing Address - Fax:206-299-0962
Practice Address - Street 1:3515 NE 45TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5640
Practice Address - Country:US
Practice Address - Phone:206-402-5483
Practice Address - Fax:206-299-0962
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010848225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1053593152Medicaid
WA8503427Medicaid
WAP00836816OtherRR MEDICARE
WA8503427Medicaid