Provider Demographics
NPI:1255700688
Name:SHAFER, CHAD DONALD (PT)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:DONALD
Last Name:SHAFER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:DR
Other - First Name:CHAD
Other - Middle Name:D
Other - Last Name:SHAFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:1346 WINDING RIDGE DR
Mailing Address - Street 2:3A
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7567
Mailing Address - Country:US
Mailing Address - Phone:269-326-0607
Mailing Address - Fax:
Practice Address - Street 1:1787 W BIG BEAVER RD
Practice Address - Street 2:SUITE #250
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3548
Practice Address - Country:US
Practice Address - Phone:248-649-4193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010174242251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic