Provider Demographics
NPI:1457588113
Name:SHIPE, TIARA D (PT)
Entity Type:Individual
Prefix:
First Name:TIARA
Middle Name:D
Last Name:SHIPE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:845 WATER STREET
Mailing Address - City:NORTHUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17857-0064
Mailing Address - Country:US
Mailing Address - Phone:570-473-3912
Mailing Address - Fax:570-473-8731
Practice Address - Street 1:845 WATER STREET
Practice Address - Street 2:
Practice Address - City:NORTHUMBERLAND
Practice Address - State:PA
Practice Address - Zip Code:17857-0064
Practice Address - Country:US
Practice Address - Phone:570-473-3912
Practice Address - Fax:570-473-8731
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPT019919208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation