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Individual
MR. SHAWN EDYVEAN
Active
Individual
MR. SHAWN EDYVEAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501010780
MI
225100000X
Physical Therapist
9719-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40371700
—
WI
Enumeration date
08/01/2007
Last updated
05/17/2012
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