Basic Information
| Provider Information | |||||||||
| NPI: | 1457588113 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHIPE | ||||||||
| FirstName: | TIARA | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64 | ||||||||
| Address2: | 845 WATER STREET | ||||||||
| City: | NORTHUMBERLAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178570064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704733912 | ||||||||
| FaxNumber: | 5704738731 | ||||||||
| Practice Location | |||||||||
| Address1: | 845 WATER STREET | ||||||||
| Address2: | |||||||||
| City: | NORTHUMBERLAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178570064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704733912 | ||||||||
| FaxNumber: | 5704738731 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2009 | ||||||||
| LastUpdateDate: | 10/21/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | PT019919 | PA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.