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NPI Code Detail

MEDICARE: ANNE C SHEA DPT

MEDICARE: ANNE C SHEA DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist41834CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CB225993OTHERCAMEDICARE PTAN

General Provider Information

NPI Number : 1043615891
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNE C SHEA DPT
Provider Business Mailing Address
First Line : 317 N EL CAMINO REAL STE 210
Second Line :
City : ENCINITAS
State : CA
Zip : 92024-2813
Country : US
Telephone Number : 760-634-0248
Fax Number : 760-634-1782
Provider Business Practice Location Address
First Line : 4435 EASTGATE MALL
Second Line : #120
City : SAN DIEGO
State : CA
Zip : 92121-1982
Country : US
Telephone Number : 858-587-8669
Fax Number : 858-587-8675
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2014
Last Update Date : 10/27/2023

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Directions to “ ANNE C SHEA DPT” Practice Location

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