Provider Demographics
NPI:1790914307
Name:WILLIAMS, SHANA M (DPT)
Entity Type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:SHANA
Other - Middle Name:M
Other - Last Name:LONGEY (MAIDEN NAME)
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:73 NEWTON RD
Mailing Address - Street 2:STE 101
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-2424
Mailing Address - Country:US
Mailing Address - Phone:978-388-7272
Mailing Address - Fax:978-388-7373
Practice Address - Street 1:282 ROUTE 101
Practice Address - Street 2:UNIT 11
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-1706
Practice Address - Country:US
Practice Address - Phone:603-672-5125
Practice Address - Fax:603-672-5126
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3448174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHT400150633Medicare PIN