Provider Demographics
NPI:1831190388
Name:SHIRK, NANCY M (PT)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:M
Last Name:SHIRK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 S HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8106
Mailing Address - Country:US
Mailing Address - Phone:561-575-3377
Mailing Address - Fax:
Practice Address - Street 1:1200 UNIVERSITY BLVD
Practice Address - Street 2:#101
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5215
Practice Address - Country:US
Practice Address - Phone:561-694-1243
Practice Address - Fax:561-694-8992
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist