Provider Demographics
NPI:1043615891
Name:SHEA, ANNE C (DPT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:C
Last Name:SHEA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:317 N EL CAMINO REAL STE 210
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2813
Mailing Address - Country:US
Mailing Address - Phone:760-634-0248
Mailing Address - Fax:760-634-1782
Practice Address - Street 1:4435 EASTGATE MALL
Practice Address - Street 2:#120
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1982
Practice Address - Country:US
Practice Address - Phone:858-587-8669
Practice Address - Fax:858-587-8675
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA41834225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB225993OtherMEDICARE PTAN