Provider Demographics
NPI:1174874630
Name:VANQUIRAY, SHALIMAR MAY (PT)
Entity type:Individual
Prefix:
First Name:SHALIMAR
Middle Name:MAY
Last Name:VANQUIRAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2675 COURT DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-1478
Mailing Address - Country:US
Mailing Address - Phone:704-824-7800
Mailing Address - Fax:704-824-2853
Practice Address - Street 1:2278 ALBERT PIKE ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4157
Practice Address - Country:US
Practice Address - Phone:501-767-0808
Practice Address - Fax:501-767-0832
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist