Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT007848L | PA |
Y | 2251P0200X | Physical Therapist - Pediatrics | PT007848L | PA |
NPI | 1124235718 |
---|---|
Provider Name | Mrs. Deborah Anne Shelley-Moore |
First Address | Chadds Ford, PA 19317-9219 |
Second Address | Havertown, PA 19083-4904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 16/04/2008 |