Provider Demographics
NPI:1790157741
Name:SHIRE, DEVON (PT)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:SHIRE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1014
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1014
Mailing Address - Country:US
Mailing Address - Phone:732-855-9751
Mailing Address - Fax:732-855-9755
Practice Address - Street 1:365 GEROGES RD
Practice Address - Street 2:SUITE 4
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-1639
Practice Address - Country:US
Practice Address - Phone:732-438-3736
Practice Address - Fax:732-855-9751
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01630000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist