Provider Demographics
NPI:1760492870
Name:SHEA, DEBORAH
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 EVERHART RD
Mailing Address - Street 2:ST 1
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4838
Mailing Address - Country:US
Mailing Address - Phone:361-994-5224
Mailing Address - Fax:361-992-1933
Practice Address - Street 1:5440 EVERHART RD
Practice Address - Street 2:ST 1
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4838
Practice Address - Country:US
Practice Address - Phone:361-994-5224
Practice Address - Fax:361-992-1933
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1032688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81478TOtherBCBS NUMBER