Basic Information
| Provider Information | |||||||||
| NPI: | 1720563927 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEA | ||||||||
| FirstName: | MARY | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 655 NORTHERN BLVD | ||||||||
| Address2: | |||||||||
| City: | SOUTH ABINGTON TOWNSHIP | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184118740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708429323 | ||||||||
| FaxNumber: | 5708429362 | ||||||||
| Practice Location | |||||||||
| Address1: | 82 N MAIN ST STE 1 | ||||||||
| Address2: | |||||||||
| City: | CARBONDALE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184071914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702820200 | ||||||||
| FaxNumber: | 5702822229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2018 | ||||||||
| LastUpdateDate: | 10/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT027210 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.