Provider Demographics
NPI:1982883799
Name:SHANKMAN, KIM MICHELLE (DPT)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:MICHELLE
Last Name:SHANKMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 79TH ST
Mailing Address - Street 2:APARTMENT 6D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6212
Mailing Address - Country:US
Mailing Address - Phone:212-689-2165
Mailing Address - Fax:
Practice Address - Street 1:2109 BROADWAY STE 204
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2106
Practice Address - Country:US
Practice Address - Phone:212-799-0160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023511225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist