MEDICARE: MRS. VICKIE SHUFFITT P.T.

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	225100000X	Physical Therapist	PT 26113	FL

General Provider Information

NPI Number	:	1750788287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICKIE SHUFFITT P.T.

Provider Business Mailing Address
First Line	:	2081 WILLOW HAMMOCK CIR UNIT 304
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33983-6717
Country	:	US
Telephone Number	:	931-335-1256
Fax Number	:

Provider Business Practice Location Address
First Line	:	21281 GRAYTON TER
Second Line	:	DOUGLAS T JACOBSON VETERANS HOME
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33954-3109
Country	:	US
Telephone Number	:	941-613-0919
Fax Number	:

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

Provider Enumeration Date	:	11/26/2014
Last Update Date	:	11/26/2014

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