Mr Shane Marlon Pederson, PT is a
Physical Therapist based in Palmhurst, Texas. Mr Shane Marlon Pederson is licensed to practice in Texas (license number 1155757) and his current practice location is
123 West Mile 3 Road, Suite A-103, Palmhurst, Texas. He can be reached at his office (for appointments etc.) via phone at
(956) 585-9889.
NPI number for Mr Shane Marlon Pederson is 1003066853 and his current mailing address is 123 West Mile 3 Road, Suite A-103, Palmhurst, Texas. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1003066853.
Healthcare Provider's Profile
Full Name | Mr Shane Marlon Pederson |
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Gender | Male |
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Speciality | Physical Therapist |
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Location | 123 West Mile 3 Road, Palmhurst, Texas |
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Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
NPI Data:
- NPI Number: 1003066853
- Provider Enumeration Date: 09/29/2008
- Last Update Date: 07/24/2013
Medical Identifiers
Medical identifiers for Mr Shane Marlon Pederson such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1003066853 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
225100000X | Physical Therapist | 1155757 (Texas) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Shane Marlon Pederson is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Mr Shane Marlon Pederson, PT 123 West Mile 3 Road, Suite A-103, Palmhurst, TX 78573 Ph: (956) 585-9889 | Mr Shane Marlon Pederson, PT 123 West Mile 3 Road, Suite A-103, Palmhurst, TX 78573 Ph: (956) 585-9889 |
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