Provider Demographics
NPI:1467549386
Name:SHIVERS, KAREN LEE (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LEE
Last Name:SHIVERS
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 1:3550 DEER RUN S
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3551
Mailing Address - Country:US
Mailing Address - Phone:727-480-2809
Mailing Address - Fax:
Practice Address - Street 1:3550 DEER RUN S
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3551
Practice Address - Country:US
Practice Address - Phone:727-480-2809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 7695225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL678945596Medicaid
FL881624700Medicaid