Provider Demographics
NPI:1316692858
Name:SHYMANSKY, ROBERT ALLAN JR (PT, DPT, CSCS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALLAN
Last Name:SHYMANSKY
Suffix:JR
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:COBB ISLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20625-0386
Mailing Address - Country:US
Mailing Address - Phone:301-848-1183
Mailing Address - Fax:
Practice Address - Street 1:4470 REGENCY PL STE 100
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3085
Practice Address - Country:US
Practice Address - Phone:301-934-5336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist