Provider Demographics
NPI:1306337928
Name:SHUMBO, KATY (PT, DPT, OCS, ATC)
Entity type:Individual
Prefix:DR
First Name:KATY
Middle Name:
Last Name:SHUMBO
Suffix:
Gender:F
Credentials:PT, DPT, OCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 NEWCASTLE WALK
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6087
Mailing Address - Country:US
Mailing Address - Phone:401-338-3265
Mailing Address - Fax:
Practice Address - Street 1:116 NEWCASTLE WALK
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6087
Practice Address - Country:US
Practice Address - Phone:401-338-3265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist