Provider Demographics
NPI:1215440177
Name:SHAY, MICHAEL (LMT CNC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:SHAY
Suffix:
Gender:M
Credentials:LMT CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 N COURT ST TRLR 5D
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-2005
Mailing Address - Country:US
Mailing Address - Phone:641-472-3638
Mailing Address - Fax:
Practice Address - Street 1:2000 N COURT ST TRLR 5D
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-5255
Practice Address - Country:US
Practice Address - Phone:641-472-3638
Practice Address - Fax:641-472-3638
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006367225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist