Provider Demographics
NPI:1962103010
Name:SHAVER, COLLIN MICHAEL (PTA)
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:MICHAEL
Last Name:SHAVER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8833 TOWNSHIP ROAD 95
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-9658
Mailing Address - Country:US
Mailing Address - Phone:567-230-6436
Mailing Address - Fax:
Practice Address - Street 1:3400 CALLOWAY DR STE 603
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2514
Practice Address - Country:US
Practice Address - Phone:661-377-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51241225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty