MEDICARE: MRS. SHANNA LYNN RATH DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	5501015530	MI

General Provider Information

NPI Number	:	1427189349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNA LYNN RATH DPT

Provider Business Mailing Address
First Line	:	6019 COOLEY LAKE RD
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48327-2907
Country	:	US
Telephone Number	:	989-293-2434
Fax Number	:

Provider Business Practice Location Address
First Line	:	33200 W 14 MILE RD
Second Line	:	SUITE 160
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3563
Country	:	US
Telephone Number	:	248-538-7607
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	04/21/2015

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