Provider Demographics
NPI:1275934192
Name:SHIREY, MARY PAT
Entity Type:Individual
Prefix:
First Name:MARY PAT
Middle Name:
Last Name:SHIREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40207 FRANKFORD SCHOOL ROAD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19945
Mailing Address - Country:US
Mailing Address - Phone:302-732-3800
Mailing Address - Fax:302-732-4016
Practice Address - Street 1:40207 FRANKFORD SCHOOL RD.
Practice Address - Street 2:
Practice Address - City:FRANKFORD
Practice Address - State:DE
Practice Address - Zip Code:19945
Practice Address - Country:US
Practice Address - Phone:302-732-3800
Practice Address - Fax:302-732-4016
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ2-0000985225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant