Provider Demographics
NPI:1366943029
Name:SHUART, FELIWELYN MATALINES ABIS (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:FELIWELYN
Middle Name:MATALINES ABIS
Last Name:SHUART
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1010 WADSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:EAST TAWAS
Mailing Address - State:MI
Mailing Address - Zip Code:48730-9774
Mailing Address - Country:US
Mailing Address - Phone:989-362-0197
Mailing Address - Fax:989-362-9208
Practice Address - Street 1:110 BEECH ST STE A
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-8314
Practice Address - Country:US
Practice Address - Phone:989-362-0197
Practice Address - Fax:989-362-9208
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
5501005588225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist