MEDICARE: SHAULS INDIVIDUALIZED PHYSICAL THERAPY, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1154482016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAULS INDIVIDUALIZED PHYSICAL THERAPY, PC

Provider Business Mailing Address
First Line	:	4123 MARTIN RD
Second Line	:	SUITE 201
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48390-4151
Country	:	US
Telephone Number	:	248-366-9170
Fax Number	:	248-366-9176

Provider Business Practice Location Address
First Line	:	4123 MARTIN RD
Second Line	:	SUITE 201
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48390-4151
Country	:	US
Telephone Number	:	248-366-9170
Fax Number	:	248-366-9176

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. MICHELE LAWRENCE
Credential	:
Telephone Number	:	248-366-9170

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	11/08/2007

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