Provider Demographics
NPI:1427136340
Name:SHAVER, MICHELLE D (PTA)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:D
Last Name:SHAVER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SADDLE BRK
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-5142
Mailing Address - Country:US
Mailing Address - Phone:864-222-0335
Mailing Address - Fax:
Practice Address - Street 1:100 HEALTHY WAY # 1110
Practice Address - Street 2:ANDERSON PHYSICAL THERAPY
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2067
Practice Address - Country:US
Practice Address - Phone:864-261-3099
Practice Address - Fax:864-261-6617
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC910225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant