MEDICARE: SHIRLEY J GEORGE

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	225100000X	Physical Therapist	5501007388	MI

General Provider Information

NPI Number	:	1215432083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY J GEORGE

Provider Business Mailing Address
First Line	:	40496 MILL ROAD CT E
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48375-5019
Country	:	US
Telephone Number	:	248-347-2586
Fax Number	:

Provider Business Practice Location Address
First Line	:	21450 ARCHWOOD CIR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336-4127
Country	:	US
Telephone Number	:	248-426-6926
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2018
Last Update Date	:	03/26/2018

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