Provider Demographics
NPI:1144766650
Name:REUVEN, SHONY (DPT)
Entity Type:Individual
Prefix:
First Name:SHONY
Middle Name:
Last Name:REUVEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5896 DIXIE HWY STE B
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4503
Mailing Address - Country:US
Mailing Address - Phone:248-461-6674
Mailing Address - Fax:248-461-6594
Practice Address - Street 1:5896 DIXIE HWY STE B
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-4503
Practice Address - Country:US
Practice Address - Phone:248-461-6674
Practice Address - Fax:248-461-6594
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017921225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist