Provider Demographics
NPI:1598858227
Name:SHIVER, PAULINE (PT)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:SHIVER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:MARY
Other - Last Name:SWEANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3714 GUARDIAN AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2974
Mailing Address - Country:US
Mailing Address - Phone:252-247-2101
Mailing Address - Fax:252-247-4675
Practice Address - Street 1:303 N 35TH ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3105
Practice Address - Country:US
Practice Address - Phone:252-247-2738
Practice Address - Fax:252-240-3882
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC068V2OtherBCBS NC
NC7212393Medicaid
NC7212393Medicaid