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General NPI Number Information
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NPI Number | 1780761213
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Entity Type | Individual
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Provider Name | PATRICIA MAE SHAFER PTA
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 10/06/2015
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Provider Practice Location Address
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Address Line | 8603 BROADWAY ST SUITE 101
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City | PEARLAND
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State | TX
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Zip | 77584-8171
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Country | US
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Telephone | 832-658-5160
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Fax | 832-658-5164
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Provider Business Mailing Address
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Address Line | 8603 BROADWAY ST SUITE 101
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City | PEARLAND
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State | TX
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Zip | 77584-8171
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Country | US
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Telephone | 832-658-5160
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Fax | 832-658-5164
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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 | 2086031
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License Number State | TX
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