Individual
AMY K SHOUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
111 W JEFFERSON BLVD STE 100, SOUTH BEND, IN 46601-1993
(574) 647-2627
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05006885A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300059339
—
IN
01
—
IN3678035
MEDICARE PTAN
IN
Enumeration date
02/15/2022
Last updated
04/29/2022
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