Provider Demographics
NPI:1073262507
Name:SHINKLE, WILLIAM (DPT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:SHINKLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 NW 53RD AVE STE C
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-4810
Mailing Address - Country:US
Mailing Address - Phone:352-378-9090
Mailing Address - Fax:
Practice Address - Street 1:4615 NW 53RD AVE STE C
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-4810
Practice Address - Country:US
Practice Address - Phone:352-378-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP21105225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist