Provider Demographics
NPI:1033102587
Name:FABRIZIO, SHAYNA LEWIS (PT)
Entity Type:Individual
Prefix:MS
First Name:SHAYNA
Middle Name:LEWIS
Last Name:FABRIZIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 MIAMI ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-1934
Mailing Address - Country:US
Mailing Address - Phone:419-448-5533
Mailing Address - Fax:419-448-5559
Practice Address - Street 1:676 MIAMI ST
Practice Address - Street 2:SUITE A
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-1934
Practice Address - Country:US
Practice Address - Phone:419-448-5533
Practice Address - Fax:419-448-5559
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT07596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2273007Medicaid
OH2273007Medicaid