Provider Demographics
NPI:1538272067
Name:EMATA, SHAZER A (RPT)
Entity type:Individual
Prefix:
First Name:SHAZER
Middle Name:A
Last Name:EMATA
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6540 MILLENNIUM
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-7848
Mailing Address - Country:US
Mailing Address - Phone:517-703-1930
Mailing Address - Fax:517-703-1940
Practice Address - Street 1:6540 MILLENNIUM
Practice Address - Street 2:SUITE 110
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-7848
Practice Address - Country:US
Practice Address - Phone:517-703-1930
Practice Address - Fax:517-703-1940
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501006693225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist