Provider Demographics
NPI:1962505586
Name:SHUMAKE, SUE ANNE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:ANNE
Last Name:SHUMAKE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11094 OLD HWY 51 N
Mailing Address - Street 2:
Mailing Address - City:ARBOR VITAE
Mailing Address - State:WI
Mailing Address - Zip Code:54568
Mailing Address - Country:US
Mailing Address - Phone:715-356-2109
Mailing Address - Fax:
Practice Address - Street 1:586 SHEPARD STREET
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501
Practice Address - Country:US
Practice Address - Phone:715-365-5252
Practice Address - Fax:715-365-5258
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1286019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant