Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT006146 | GA |
N | 2251S0007X | Physical Therapist - Sports | PT006146 | GA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT006146 | GA |
NPI | 1396714143 |
---|---|
Provider Name | Mr. Michael Shockley Shiver |
First Address | Meigs, GA 31765-3812 |
Second Address | Camilla, GA 31730-1809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00894297A | (05) | GA |
65BBBKL | (02) | GA |
P00107971 | PALMETTO GBA - RR MEDICAR (01) | |
P27787 | (02) |