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1386218519 NPI number — SHELBY LEE MYERS DPT

NPI Number: 1386218519
Health Care Provider/Practitioner: SHELBY LEE MYERS DPT

Information about “1386218519” NPI (SHELBY LEE MYERS DPT) exists in 1386218519 in HTML format HTML  |  1386218519 in plain Text format TXT  |  1386218519 in PDF (Portable Document Format) PDF  |  1386218519 in an XML format XML  formats.

NPI Number : 1386218519 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1386218519",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MYERS",
    "FirstName": "SHELBY",
    "MiddleName": "LEE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "100 MICHIGAN ST NE # MC845",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GRAND RAPIDS",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49503-2560",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6201 68TH ST SE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CALEDONIA",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49316",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "231-291-8020",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/12/2021",
    "LastUpdateDate": "10/18/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "5501018837",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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