Provider Demographics
NPI:1699010678
Name:KIRCHNER, SHANNEN M (DPT)
Entity Type:Individual
Prefix:
First Name:SHANNEN
Middle Name:M
Last Name:KIRCHNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 EAGLE ROCK AVE
Mailing Address - Street 2:102
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3167
Mailing Address - Country:US
Mailing Address - Phone:973-887-9000
Mailing Address - Fax:973-887-3816
Practice Address - Street 1:218 RIDGEDALE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-2109
Practice Address - Country:US
Practice Address - Phone:973-359-0777
Practice Address - Fax:973-359-0778
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01476200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist