Kate Shiver
Individual provider Active NPI Physical Therapist · Baxley, GA
NPI 1043833429 · NPPES record last updated May 20, 2020
Key facts
- NPI
- 1043833429
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT12030 (GA)
- Practice address
- 118 Azalea Rd Ste 11
Baxley, GA 31513-9197 - Phone
- (912) 705-2855
- NPI assigned
- May 20, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT12030 | GA | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT12030 | GA | Yes |
Addresses
Primary practice location
118 Azalea Rd Ste 11
Baxley, GA 31513-9197
Mailing address
118 Azalea Rd Ste 11
Baxley, GA 31513-9197
Phone (912) 705-2855
Other providers in Baxley, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 20, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.