Provider Demographics
NPI:1124431937
Name:SHOENFELT, JAMES IV
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:SHOENFELT
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2172 ALWORTH TER
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6431
Mailing Address - Country:US
Mailing Address - Phone:561-383-0766
Mailing Address - Fax:
Practice Address - Street 1:2172 ALWORTH TER
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6431
Practice Address - Country:US
Practice Address - Phone:561-383-0766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26323225100000X
NJ40QA00929600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist