Provider Demographics
NPI:1154874501
Name:SHACKLES, JAMIE (DPT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:SHACKLES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 N SYLVANIA AVE
Mailing Address - Street 2:FRONT 2
Mailing Address - City:ROCKLEDGE
Mailing Address - State:PA
Mailing Address - Zip Code:19046-4271
Mailing Address - Country:US
Mailing Address - Phone:215-307-6228
Mailing Address - Fax:
Practice Address - Street 1:100 GREEN LANE
Practice Address - Street 2:SUITE 1
Practice Address - City:BRISTOL
Practice Address - State:BUCKS
Practice Address - Zip Code:19007
Practice Address - Country:UM
Practice Address - Phone:215-826-0166
Practice Address - Fax:215-826-0285
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0253842251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic