Provider Demographics
NPI:1639620248
Name:GILBERT, SHANE (DPT)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:GILBERT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 GREENBRIAR RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-9726
Mailing Address - Country:US
Mailing Address - Phone:717-515-5893
Mailing Address - Fax:
Practice Address - Street 1:2405 KNOBHILL RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4782
Practice Address - Country:US
Practice Address - Phone:717-268-4037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist