Healthcare Provider Details

I. General information

NPI: 1033102587
Provider Name (Legal Business Name): SHAYNA LEWIS FABRIZIO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 MIAMI ST SUITE A
TIFFIN OH
44883-1934
US

IV. Provider business mailing address

676 MIAMI ST SUITE A
TIFFIN OH
44883-1934
US

V. Phone/Fax

Practice location:
  • Phone: 419-448-5533
  • Fax: 419-448-5559
Mailing address:
  • Phone: 419-448-5533
  • Fax: 419-448-5559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT07596
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: