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Individual
MR. SHANE FAMILLE
Active
Individual
MR. SHANE FAMILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, ATC
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
Primary
40QA01317800
NJ
2255A2300X
Athletic Trainer
25MT00125600
NJ
Other
Enumeration date
08/24/2006
Last updated
02/01/2010
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