Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 2359 | AZ |
NPI | 1154399707 |
---|---|
Provider Name | Richard Shumway |
First Address | Washington, DC 06320 |
Second Address | Washington, DC 06320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 08/07/2007 |