Provider Demographics
NPI:1811257199
Name:SHANLINE, JEANNE-MARIE (MPT)
Entity type:Individual
Prefix:
First Name:JEANNE-MARIE
Middle Name:
Last Name:SHANLINE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JEANNE-MARIE
Other - Middle Name:
Other - Last Name:LANZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:13 GREEN ACRE WAY
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-2704
Mailing Address - Country:US
Mailing Address - Phone:609-221-2668
Mailing Address - Fax:
Practice Address - Street 1:200 WHITE HORSE PIKE STE 200
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1737
Practice Address - Country:US
Practice Address - Phone:609-221-2668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-00023832251P0200X
NJ40QA012165002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics