Provider Demographics
NPI:1760978415
Name:SHIVERS ENTERPRISES, INC
Entity Type:Organization
Organization Name:SHIVERS ENTERPRISES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:727-480-2809
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:727-333-7667
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:727-333-7667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7695225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL678945596Medicaid
FL881624700Medicaid
FL812403500Medicaid