Provider Demographics
NPI:1831489889
Name:LONGPRE, SHEILA MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:MARIE
Last Name:LONGPRE
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 1:7848 CARAWAY PL
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-7935
Mailing Address - Country:US
Mailing Address - Phone:317-997-2016
Mailing Address - Fax:
Practice Address - Street 1:830 CLOUDY WING DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1094
Practice Address - Country:US
Practice Address - Phone:317-881-6429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003640A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN225200000XMedicare Oscar/Certification