Provider Demographics
NPI:1245288224
Name:MCSHANE, JESSICA B (DPT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:B
Last Name:MCSHANE
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 1:209 CATTAIL LN
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-1892
Mailing Address - Country:US
Mailing Address - Phone:215-284-9333
Mailing Address - Fax:
Practice Address - Street 1:520 BECKETT RD STE 200
Practice Address - Street 2:
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-1732
Practice Address - Country:US
Practice Address - Phone:856-467-3421
Practice Address - Fax:856-467-3421
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012989L225100000X
NJ40QA02243300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist