Provider Demographics
NPI:1285249672
Name:SHIRLEY, EMMA NICOLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:NICOLE
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 ELLISVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-6999
Mailing Address - Country:US
Mailing Address - Phone:919-208-9852
Mailing Address - Fax:
Practice Address - Street 1:7965 HERITAGE VILLAGE PLZ
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3077
Practice Address - Country:US
Practice Address - Phone:571-486-1899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist