MEDICARE: PATRICIA MAE SHAFER PTA

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	225200000X	Physical Therapy Assistant	2086031	TX

General Provider Information

NPI Number	:	1780761213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA MAE SHAFER PTA

Provider Business Mailing Address
First Line	:	8603 BROADWAY ST
Second Line	:	SUITE 101
City	:	PEARLAND
State	:	TX
Zip	:	77584-8171
Country	:	US
Telephone Number	:	832-658-5160
Fax Number	:	832-658-5164

Provider Business Practice Location Address
First Line	:	8603 BROADWAY ST
Second Line	:	SUITE 101
City	:	PEARLAND
State	:	TX
Zip	:	77584-8171
Country	:	US
Telephone Number	:	832-658-5160
Fax Number	:	832-658-5164

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	10/06/2015

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