Provider Demographics
NPI:1548504285
Name:SHIELDS, JOHN MONTGOMERY II (LPTA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MONTGOMERY
Last Name:SHIELDS
Suffix:II
Gender:M
Credentials:LPTA
Other - Prefix:MR
Other - First Name:MONTY
Other - Middle Name:
Other - Last Name:SHIELDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPTA
Mailing Address - Street 1:714 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:NC
Mailing Address - Zip Code:28159-1622
Mailing Address - Country:US
Mailing Address - Phone:704-212-8013
Mailing Address - Fax:
Practice Address - Street 1:116 LANE DR
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:NC
Practice Address - Zip Code:27370-9343
Practice Address - Country:US
Practice Address - Phone:336-434-1706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1600225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant