Provider Demographics
NPI:1457961195
Name:SHEA, JOHN (DPT)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:SHEA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 NEWBURG RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1225
Mailing Address - Country:US
Mailing Address - Phone:480-298-3356
Mailing Address - Fax:
Practice Address - Street 1:2624 RING RD # 101
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-9118
Practice Address - Country:US
Practice Address - Phone:270-900-4052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
KY008036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY008036OtherKENTUCKY PHYSICAL THERAPY LICENSE NUMBER