Healthcare Provider Details

I. General information

NPI: 1346188521
Provider Name (Legal Business Name): VICTOR SHEM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 S ALMA SCHOOL RD STE 101
MESA AZ
85210-2078
US

IV. Provider business mailing address

2408 LINDEN AVE
KNOXVILLE TN
37917-8222
US

V. Phone/Fax

Practice location:
  • Phone: 480-335-8882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP049385T
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13366
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP051225T
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: