Provider Demographics
NPI:1689345167
Name:SHEA, CAROLINE ROSE (DPT)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ROSE
Last Name:SHEA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 7TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4971
Mailing Address - Country:US
Mailing Address - Phone:907-415-4222
Mailing Address - Fax:907-206-7156
Practice Address - Street 1:530 7TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4971
Practice Address - Country:US
Practice Address - Phone:907-415-4222
Practice Address - Fax:907-206-7156
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13125225100000X
AK187471225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist