Provider Demographics
NPI:1689195299
Name:PURSER, SHANE
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:PURSER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 BETHANY CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-5862
Mailing Address - Country:US
Mailing Address - Phone:972-533-0298
Mailing Address - Fax:
Practice Address - Street 1:1300 N CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-1009
Practice Address - Country:US
Practice Address - Phone:972-578-2212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist