Provider Demographics
NPI:1023872306
Name:SHIELDS, JAZMIN A (PT, DPT)
Entity type:Individual
Prefix:
First Name:JAZMIN
Middle Name:A
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 OLD INDIANA RD
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-6903
Mailing Address - Country:US
Mailing Address - Phone:724-762-6654
Mailing Address - Fax:
Practice Address - Street 1:100 LITTLE DR
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3345
Practice Address - Country:US
Practice Address - Phone:724-339-1071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT032091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist