Provider Demographics
NPI:1215088414
Name:SHEA, KATRINA MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:MARIE
Last Name:SHEA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:ABATIELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:335 HIGHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410
Mailing Address - Country:US
Mailing Address - Phone:203-699-9264
Mailing Address - Fax:203-271-1241
Practice Address - Street 1:335 HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410
Practice Address - Country:US
Practice Address - Phone:203-699-9264
Practice Address - Fax:203-271-1241
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0001076225100000X
CT14.010423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist