Provider Demographics
NPI:1831463694
Name:SHEA, DEBORAH MARGARET (PTA)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:MARGARET
Last Name:SHEA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 W HEARTHSTONE DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1234
Mailing Address - Country:US
Mailing Address - Phone:518-459-4459
Mailing Address - Fax:
Practice Address - Street 1:91 FIDDLERS LN
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-5349
Practice Address - Country:US
Practice Address - Phone:518-785-8591
Practice Address - Fax:518-785-8502
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-26
Last Update Date:2012-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000108-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant