Provider Demographics
NPI:1992922538
Name:SHAY, JAMES PETER (PT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:PETER
Last Name:SHAY
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:101 W EST SYCAMORE ST
Mailing Address - Street 2:PO BOX 602
Mailing Address - City:WAKARUSA
Mailing Address - State:IN
Mailing Address - Zip Code:46573
Mailing Address - Country:US
Mailing Address - Phone:574-862-3128
Mailing Address - Fax:574-862-3128
Practice Address - Street 1:22818 OLD US 20
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-9150
Practice Address - Country:US
Practice Address - Phone:574-389-1231
Practice Address - Fax:574-389-1232
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN05004152A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN05004152AOtherPHYSICAL THERAPY