Provider Demographics
NPI:1558541532
Name:SHAVER, RACHELLE L (PT)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:L
Last Name:SHAVER
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 1:4261 WILSON CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-9069
Mailing Address - Country:US
Mailing Address - Phone:316-218-2251
Mailing Address - Fax:
Practice Address - Street 1:7548 PRESTON RD STE 145
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5684
Practice Address - Country:US
Practice Address - Phone:316-218-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1121200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist