Provider Demographics
NPI:1417425414
Name:REESE, SHEA V (LPTA)
Entity Type:Individual
Prefix:
First Name:SHEA
Middle Name:V
Last Name:REESE
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 FRIENDSHIP RD
Mailing Address - Street 2:
Mailing Address - City:ROBELINE
Mailing Address - State:LA
Mailing Address - Zip Code:71469-5619
Mailing Address - Country:US
Mailing Address - Phone:318-332-6526
Mailing Address - Fax:
Practice Address - Street 1:902 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SAN AUGUSTINE
Practice Address - State:TX
Practice Address - Zip Code:75972-2316
Practice Address - Country:US
Practice Address - Phone:936-275-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA4232225200000X
TX2084020225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant