Provider Demographics
NPI:1285601864
Name:SHIMP, JAMES ALAN (MPT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALAN
Last Name:SHIMP
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
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Mailing Address - Street 1:209 PORCHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PITTSGROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:08318-4522
Mailing Address - Country:US
Mailing Address - Phone:856-358-7797
Mailing Address - Fax:856-358-3449
Practice Address - Street 1:45 BROAD ST
Practice Address - Street 2:PHYSICAL THERAPY SERVICES,RUTALA,INGEMI,BARBARA,LLC
Practice Address - City:ELMER
Practice Address - State:NJ
Practice Address - Zip Code:08318-2201
Practice Address - Country:US
Practice Address - Phone:856-358-6200
Practice Address - Fax:856-358-0077
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJQAO5832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ316704Medicare PIN
NJ193525Medicare PIN