Provider Demographics
NPI:1750788287
Name:SHUFFITT, VICKIE (PT)
Entity type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:
Last Name:SHUFFITT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2081 WILLOW HAMMOCK CIR UNIT 304
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-6717
Mailing Address - Country:US
Mailing Address - Phone:931-335-1256
Mailing Address - Fax:
Practice Address - Street 1:21281 GRAYTON TER
Practice Address - Street 2:DOUGLAS T JACOBSON VETERANS HOME
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954-3109
Practice Address - Country:US
Practice Address - Phone:941-613-0919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 26113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist