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General NPI Number Information
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NPI Number | 1346001963
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Entity Type | Individual
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Provider Name | SHAYNE J BOLLHEIMER
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Gender | Female
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 1022 E WESLEY DR
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City | O FALLON
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State | IL
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Zip | 62269-6107
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Country | US
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Telephone | 618-744-6613
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Fax |
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Provider Business Mailing Address
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Address Line | 49 WALNUT CIR
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City | AVISTON
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State | IL
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Zip | 62216-3537
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Country | US
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Telephone | 618-929-2709
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160003017
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License Number State | IL
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