Provider Demographics
NPI:1154482016
Name:SHAULS INDIVIDUALIZED PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:SHAULS INDIVIDUALIZED PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-366-9170
Mailing Address - Street 1:4123 MARTIN RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-4151
Mailing Address - Country:US
Mailing Address - Phone:248-366-9170
Mailing Address - Fax:248-366-9176
Practice Address - Street 1:4123 MARTIN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-4151
Practice Address - Country:US
Practice Address - Phone:248-366-9170
Practice Address - Fax:248-366-9176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N84780Medicare ID - Type Unspecified