Provider Demographics
NPI:1336496371
Name:SHATZ, REBECCA SHARON (PT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SHARON
Last Name:SHATZ
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 1:2956 SAINT AUBIN AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1887
Mailing Address - Country:US
Mailing Address - Phone:734-274-0515
Mailing Address - Fax:
Practice Address - Street 1:3820 PACKARD ST STE 190
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-5017
Practice Address - Country:US
Practice Address - Phone:734-677-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist