Provider Demographics
NPI:1316071012
Name:SHIMP, PAUL WILLIAM (PTA)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:WILLIAM
Last Name:SHIMP
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 CRAYCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-4758
Mailing Address - Country:US
Mailing Address - Phone:407-375-9160
Mailing Address - Fax:
Practice Address - Street 1:48 CRAYCROFT AVE
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-4758
Practice Address - Country:US
Practice Address - Phone:407-375-9160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17408225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant