Provider Demographics
NPI:1063521706
Name:SHIMAMOTO, CINDY
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:SHIMAMOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11213 INDIAN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-4923
Mailing Address - Country:US
Mailing Address - Phone:813-968-3727
Mailing Address - Fax:
Practice Address - Street 1:10607 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-5114
Practice Address - Country:US
Practice Address - Phone:813-792-1531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT18686OtherLICENSE#