Provider Demographics
NPI:1073066924
Name:SHAPPY, ALEC
Entity Type:Individual
Prefix:
First Name:ALEC
Middle Name:
Last Name:SHAPPY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 STATE ST APT 201
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-5223
Mailing Address - Country:US
Mailing Address - Phone:207-391-9122
Mailing Address - Fax:
Practice Address - Street 1:29 STATE ST APT 201
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-5223
Practice Address - Country:US
Practice Address - Phone:207-391-9122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA4140225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant