Basic Information
| Provider Information | |||||||||
| NPI: | 1962708875 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHOVESTUL | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | O'SHEA | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 251 PEOPLES WAY | ||||||||
| Address2: | |||||||||
| City: | HOCKESSIN | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197071908 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 63 DELAWARE AVENUE | ||||||||
| Address2: | 053 MCKINLY LAB | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3028318893 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2011 | ||||||||
| LastUpdateDate: | 02/10/2011 | ||||||||
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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 | J1-0002668 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.