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General NPI Number Information
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NPI Number | 1689345167
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Entity Type | Individual
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Provider Name | CAROLINE ROSE SHEA DPT
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Gender | Female
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Dates
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Enumeration Date | 09/23/2021
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 530 7TH AVE STE 1
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City | FAIRBANKS
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State | AK
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Zip | 99701-4971
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Country | US
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Telephone | 907-415-4222
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Fax | 907-206-7156
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Provider Business Mailing Address
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Address Line | 530 7TH AVE STE 1
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City | FAIRBANKS
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State | AK
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Zip | 99701-4971
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Country | US
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Telephone | 907-415-4222
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Fax | 907-206-7156
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 13125
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 187471
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License Number State | AK
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