Provider Demographics
NPI:1386668150
Name:SHEA, JAMES (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:SHEA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 ROUTE 236
Mailing Address - Street 2:SUITE 210
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-6000
Mailing Address - Country:US
Mailing Address - Phone:207-439-2675
Mailing Address - Fax:207-439-4965
Practice Address - Street 1:37 ROUTE 236
Practice Address - Street 2:SUITE 210
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-6000
Practice Address - Country:US
Practice Address - Phone:207-439-4965
Practice Address - Fax:207-439-4965
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15785225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68504OtherBC PROVIDER #
MAY69368Medicare ID - Type UnspecifiedMEDICARE PROVIDER #