Provider Demographics
NPI:1801973326
Name:KIRSCHNER, SHANA L (MPT)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:L
Last Name:KIRSCHNER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 167
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:NH
Mailing Address - Zip Code:03450-0167
Mailing Address - Country:US
Mailing Address - Phone:603-209-5727
Mailing Address - Fax:
Practice Address - Street 1:319 E DUNSTABLE RD
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-4207
Practice Address - Country:US
Practice Address - Phone:603-966-5817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2881225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH08Y005173NH01OtherANTHEM PROVIDER #
NH30394051Medicaid
NH30394051Medicaid