Provider Demographics
NPI:1417241019
Name:FLEISCHAUER, SHIRL L (LMT)
Entity Type:Individual
Prefix:
First Name:SHIRL
Middle Name:L
Last Name:FLEISCHAUER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2356 SUNDEW AVE
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-9052
Mailing Address - Country:US
Mailing Address - Phone:614-595-0361
Mailing Address - Fax:
Practice Address - Street 1:1515 W LANE AVE STE 2
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3952
Practice Address - Country:US
Practice Address - Phone:614-595-0361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.016183225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist