Provider Demographics
NPI:1346232329
Name:SHEA PHYSICAL THERAPY P C
Entity Type:Organization
Organization Name:SHEA PHYSICAL THERAPY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:361-994-5224
Mailing Address - Street 1:5440 EVERHART RD
Mailing Address - Street 2:ST 1
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4838
Mailing Address - Country:US
Mailing Address - Phone:361-994-5224
Mailing Address - Fax:361-992-1933
Practice Address - Street 1:5440 EVERHART RD
Practice Address - Street 2:ST 1
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4838
Practice Address - Country:US
Practice Address - Phone:361-994-5224
Practice Address - Fax:361-992-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225100000X, 225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0021BGOtherBC BS GROUP #
TX456758Medicare ID - Type UnspecifiedMEDICARE FACILITY NUMBER