Basic Information
| Provider Information | |||||||||
| NPI: | 1962505586 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHUMAKE | ||||||||
| FirstName: | SUE | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11094 OLD HWY 51 N | ||||||||
| Address2: | |||||||||
| City: | ARBOR VITAE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153562109 | ||||||||
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| Practice Location | |||||||||
| Address1: | 586 SHEPARD STREET | ||||||||
| Address2: | |||||||||
| City: | RHINELANDER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153655252 | ||||||||
| FaxNumber: | 7153655258 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 1286019 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.