Provider Demographics
NPI:1447218565
Name:SHIELDS, GARY DARELL (PT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:DARELL
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:156 OLD KENNETT RD
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-2632
Mailing Address - Country:US
Mailing Address - Phone:610-444-8648
Mailing Address - Fax:610-444-8649
Practice Address - Street 1:3740 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3223
Practice Address - Country:US
Practice Address - Phone:610-355-7623
Practice Address - Fax:610-355-7623
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPT001156E2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic