Provider Demographics
NPI:1154399707
Name:SHUMWAY, RICHARD
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:SHUMWAY
Suffix:
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 1:2100 2ND STREET
Mailing Address - Street 2:RM 5314 USCG HQ, COMDT (CG-1122)
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:06320
Mailing Address - Country:US
Mailing Address - Phone:860-444-8402
Mailing Address - Fax:
Practice Address - Street 1:2100 2ND STREET
Practice Address - Street 2:RM 5314 USCG HQ, COMDT (CG-1122)
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:06320
Practice Address - Country:US
Practice Address - Phone:860-444-8402
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23592251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports