Provider Demographics
NPI:1184872319
Name:SHIRLEY, MARIANNE S (PT)
Entity type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:S
Last Name:SHIRLEY
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 1:220 APPLEGROVE ST NE
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-1610
Mailing Address - Country:US
Mailing Address - Phone:330-966-9166
Mailing Address - Fax:330-966-1135
Practice Address - Street 1:220 APPLEGROVE ST NE
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-1610
Practice Address - Country:US
Practice Address - Phone:330-966-9166
Practice Address - Fax:330-966-1135
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 05334225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSH4105421OtherPT PROVIDER #