Provider Demographics
NPI:1114986528
Name:MERTES, SHANNON MAE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:MAE
Last Name:MERTES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36306 UNION LK RD
Mailing Address - Street 2:APT 204
Mailing Address - City:HARRISON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48045
Mailing Address - Country:US
Mailing Address - Phone:586-291-8203
Mailing Address - Fax:
Practice Address - Street 1:49050 SCHOENHERR RD
Practice Address - Street 2:STE 600
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315
Practice Address - Country:US
Practice Address - Phone:586-566-8913
Practice Address - Fax:586-566-8739
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant