Individual
MR. SHANE FAMILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, ATC
Contact information
Practice address
17 11TH AVE, GLENDORA, NJ 08029-1333
(856) 216-0047
(856) 427-9314
Mailing address
17 11TH AVE, GLENDORA, NJ 08029-1333
(856) 216-0047
(856) 427-9314
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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