Healthcare Provider Details

I. General information

NPI: 1154482016
Provider Name (Legal Business Name): SHAULS INDIVIDUALIZED PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4123 MARTIN RD SUITE 201
COMMERCE TOWNSHIP MI
48390-4151
US

IV. Provider business mailing address

4123 MARTIN RD SUITE 201
COMMERCE TOWNSHIP MI
48390-4151
US

V. Phone/Fax

Practice location:
  • Phone: 248-366-9170
  • Fax: 248-366-9176
Mailing address:
  • Phone: 248-366-9170
  • Fax: 248-366-9176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. MICHELE LAWRENCE
Title or Position: OFFICE MANAGER
Credential:
Phone: 248-366-9170