Provider Demographics
NPI:1053692939
Name:REED, SHIRLEY A (PT DPT)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:A
Last Name:REED
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 1:47 WATER ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HALLOWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04347-1400
Mailing Address - Country:US
Mailing Address - Phone:207-460-4177
Mailing Address - Fax:207-213-6285
Practice Address - Street 1:47 WATER ST STE 101
Practice Address - Street 2:
Practice Address - City:HALLOWELL
Practice Address - State:ME
Practice Address - Zip Code:04347-1400
Practice Address - Country:US
Practice Address - Phone:207-460-4177
Practice Address - Fax:207-213-6285
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT 2790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist