Healthcare Provider Details

I. General information

NPI: 1144706409
Provider Name (Legal Business Name): KACEE LYNN SHOLL PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 WOODLAWN AVE STE 1
NAPOLEON OH
43545-1178
US

IV. Provider business mailing address

1322 WOODLAWN AVE STE 1
NAPOLEON OH
43545-1178
US

V. Phone/Fax

Practice location:
  • Phone: 419-599-0888
  • Fax: 419-599-0087
Mailing address:
  • Phone: 419-599-0888
  • Fax: 419-599-0087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017459
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: