Provider Demographics
NPI:1831991884
Name:SHIELD PHYSICAL THERAPY AND INJURY PREVENTION LLC
Entity type:Organization
Organization Name:SHIELD PHYSICAL THERAPY AND INJURY PREVENTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, ATC
Authorized Official - Phone:765-419-6203
Mailing Address - Street 1:8806 GREENMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:IN
Mailing Address - Zip Code:46774-1827
Mailing Address - Country:US
Mailing Address - Phone:765-419-6203
Mailing Address - Fax:
Practice Address - Street 1:5928 TRIER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-5231
Practice Address - Country:US
Practice Address - Phone:260-408-8352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty