Provider Demographics
NPI:1295171700
Name:GARVER, SHANE M (LPTA)
Entity type:Individual
Prefix:MR
First Name:SHANE
Middle Name:M
Last Name:GARVER
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 LONGMEADOW
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34235-5676
Mailing Address - Country:US
Mailing Address - Phone:419-799-0233
Mailing Address - Fax:
Practice Address - Street 1:1026 ALBEE FARM RD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-6213
Practice Address - Country:US
Practice Address - Phone:941-484-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA08647225200000X
FLPTA23947225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant