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Contact Information

KEVIN SHADDOCK, DPT
816 A1A N STE 307
PONTE VEDRA BEACH, FL32082-3219
 Phone: 402-190-4543
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Geriatrics

2251G0304X 65 Physical Therapist in Private Practice
Indicates primary specialty

NPI Profile & details for KEVIN SHADDOCK · (Male)

NPI # 1568940617
Status Active
Credentials DPT (Doctorate of Physical Therapy)
Entity Individual
Enumeration date 07/31/2018
Last updated 07/31/2018 - About 8 years ago
Sole proprietor 1 Yes
Identifiers
  • FL License # PT33637
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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