Provider Demographics
NPI:1598231144
Name:NEUHAUS, SHELLIE LYNN (PHYSICAL THERAPY)
Entity type:Individual
Prefix:
First Name:SHELLIE
Middle Name:LYNN
Last Name:NEUHAUS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 OREGON AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-1623
Mailing Address - Country:US
Mailing Address - Phone:616-633-9327
Mailing Address - Fax:
Practice Address - Street 1:2139 OREGON AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-1623
Practice Address - Country:US
Practice Address - Phone:616-633-9327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502002023225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty