Individual
MRS. MARILYN RAYBURN SHIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T., M.S.
Contact information
Practice address
99 E BROAD ST, CAMILLA, GA 31730-1807
(229) 336-1115
(229) 336-1151
Mailing address
4555 NORTHPOINT DR, CAMILLA, GA 31730-6749
(229) 336-0105
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT007735
GA
2251S0007X
Sports Physical Therapist
PT007735
GA
2251X0800X
Orthopedic Physical Therapist
PT007735
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
829428929A
—
GA
01
—
P00247221
PALMETTO GBA - RR MEDICAR
—
Enumeration date
03/15/2006
Last updated
06/25/2015
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