Provider Demographics
NPI:1770076267
Name:SHIREY, CONNOR SCOTT (DPT)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:SCOTT
Last Name:SHIREY
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 1:500 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-6036
Mailing Address - Country:US
Mailing Address - Phone:814-762-8356
Mailing Address - Fax:814-762-8366
Practice Address - Street 1:500 PLAZA DR
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-6036
Practice Address - Country:US
Practice Address - Phone:814-762-8356
Practice Address - Fax:814-762-8366
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT026867225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist