Provider Demographics
NPI:1790150712
Name:SHEAKLEY, JENNIFER ANN (DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:SHEAKLEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:PUELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4538 PEACH ST STE A
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1364
Mailing Address - Country:US
Mailing Address - Phone:814-864-6650
Mailing Address - Fax:814-806-2557
Practice Address - Street 1:9125 RIDGE RD STE C
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:PA
Practice Address - Zip Code:16417-9645
Practice Address - Country:US
Practice Address - Phone:814-646-6508
Practice Address - Fax:814-295-6441
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016388174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist