Provider Demographics
NPI:1811941545
Name:SHEA, DANIELLE (PT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:SHEA
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 1:2413 PROFESSIONAL DR
Mailing Address - Street 2:PO BOX 7594
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2254
Mailing Address - Country:US
Mailing Address - Phone:252-443-0808
Mailing Address - Fax:
Practice Address - Street 1:721 TILGHMAN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-6063
Practice Address - Country:US
Practice Address - Phone:910-892-5635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC067W3OtherBCBS
2743631OtherUHC
NC7275569Medicaid
7385878OtherAETNA
195347OtherMEDCOST
NC198336OtherMED RISK
NC198336OtherMED RISK
2743631OtherUHC