Provider Demographics
NPI:1720359136
Name:KIRSCHBAUM, SHEVAUN K (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SHEVAUN
Middle Name:K
Last Name:KIRSCHBAUM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SHAD ROW FL 2
Mailing Address - Street 2:
Mailing Address - City:PIERMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10968-3001
Mailing Address - Country:US
Mailing Address - Phone:845-359-0220
Mailing Address - Fax:201-660-7303
Practice Address - Street 1:105 SHAD ROW FL 2
Practice Address - Street 2:
Practice Address - City:PIERMONT
Practice Address - State:NY
Practice Address - Zip Code:10968-3001
Practice Address - Country:US
Practice Address - Phone:845-359-0220
Practice Address - Fax:201-660-7303
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01385800225100000X
NY032774225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist