Provider Demographics
NPI:1467471532
Name:GUESS, SHEILA ANNE KENNEDY (PT)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:ANNE KENNEDY
Last Name:GUESS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:ANNE
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1730 WILLIAMSBURG DR STE 3
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-8065
Mailing Address - Country:US
Mailing Address - Phone:812-284-0852
Mailing Address - Fax:812-267-0487
Practice Address - Street 1:1730 WILLIAMSBURG DR STE 3
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-8065
Practice Address - Country:US
Practice Address - Phone:812-284-0852
Practice Address - Fax:812-267-0487
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002494225100000X
IN05006703A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200330680Medicaid
IN200330680Medicaid
KY0717707Medicare PIN