Healthcare Provider Details

I. General information

NPI: 1285601864
Provider Name (Legal Business Name): JAMES ALAN SHIMP MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 BROAD ST PHYSICAL THERAPY SERVICES,RUTALA,INGEMI,BARBARA,LLC
ELMER NJ
08318-2201
US

IV. Provider business mailing address

209 PORCHTOWN RD
PITTSGROVE NJ
08318-4522
US

V. Phone/Fax

Practice location:
  • Phone: 856-358-6200
  • Fax: 856-358-0077
Mailing address:
  • Phone: 856-358-7797
  • Fax: 856-358-3449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberQAO5832
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: