Shawn Edyvean, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501010780 Issued in MI

Practice address

N5241 US Highway 45
Watersmeet, MI 49969-0009

Phone

(906) 358-4588

Fax

(906) 358-4118

NPI assigned

Aug 1, 2007

Last updated

Sep 21, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Great Northern Rehab P C

  • Physical Therapist
  • Ironwood, MI
  • NPI 1386937530
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789948800000",
    "number": "1285824581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N5241 US HIGHWAY 45",
            "city": "WATERSMEET",
            "state": "MI",
            "postal_code": "499690009",
            "telephone_number": "906-358-4588",
            "fax_number": "906-358-4118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N5241 US HIGHWAY 45",
            "city": "WATERSMEET",
            "state": "MI",
            "postal_code": "499690009",
            "telephone_number": "906-358-4588",
            "fax_number": "906-358-4118"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1310 E Cloverland Dr",
            "address_purpose": "LOCATION",
            "city": "Ironwood",
            "state": "MI",
            "postal_code": "499381606",
            "country_code": "US",
            "telephone_number": "906-932-4200",
            "fax_number": "906-932-4201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EDYVEAN",
        "first_name": "SHAWN",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-01",
        "last_updated": "2026-09-21",
        "certification_date": "2026-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "9719-024",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501010780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40371700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark R Bognar, DDS
• Emily E Busha, PA-C
• Patrick Caramella
• Steven J Fiorucci, D.O.
• Dani Friedley, PHARMD
• Kathleen Giese, LMT, BCTMB
• Robert Hansen, DC
• Jessica Anne Hoffman, FNP

• Physical Therapist in Watersmeet, MI
• Providers in Watersmeet, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.