Provider Demographics
NPI:1063954287
Name:SHIMANEK, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SHIMANEK
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 1:2329 STEARNLEE AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1936
Mailing Address - Country:US
Mailing Address - Phone:562-444-5326
Mailing Address - Fax:
Practice Address - Street 1:2599 E 28TH ST STE 206
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90755
Practice Address - Country:US
Practice Address - Phone:562-444-5326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-07
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist