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General NPI Number Information
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NPI Number | 1184163917
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Entity Type | Individual
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Provider Name | ISAAC JAMES SHETLER
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Gender | Male
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 05/09/2021
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Provider Practice Location Address
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Address Line | 1130 PARKVIEW DR
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City | TROY
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State | OH
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Zip | 45373-7579
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Country | US
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Telephone | 614-582-1216
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Fax |
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Provider Business Mailing Address
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Address Line | 1130 PARKVIEW DR
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City | TROY
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State | OH
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Zip | 45373-7579
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Country | US
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Telephone | 614-582-1216
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT006333
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT019171
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License Number State | OH
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