Provider Demographics
NPI:1982037131
Name:SHEA, CHRISTINE M (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:SHEA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HERBERT ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-5104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:607 NORTH AVE
Practice Address - Street 2:DOOR 16
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1322
Practice Address - Country:US
Practice Address - Phone:781-587-0776
Practice Address - Fax:781-587-0794
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20593225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist