Provider Demographics
NPI:1427312263
Name:SHORT, EILEEN DEIRDRE (PT)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:DEIRDRE
Last Name:SHORT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11733
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00801-4733
Mailing Address - Country:US
Mailing Address - Phone:340-626-3478
Mailing Address - Fax:
Practice Address - Street 1:6115 ESTATE SMITH BAY
Practice Address - Street 2:BOX 5
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-1324
Practice Address - Country:US
Practice Address - Phone:340-714-2348
Practice Address - Fax:340-715-2348
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI26225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist