Healthcare Provider Details

I. General information

NPI: 1558739102
Provider Name (Legal Business Name): PAUL CHARLES SHOEMAKER P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 HILYARD ST
EUGENE OR
97405-3867
US

IV. Provider business mailing address

3350 AMHERST WAY
EUGENE OR
97408-9297
US

V. Phone/Fax

Practice location:
  • Phone: 541-687-9211
  • Fax:
Mailing address:
  • Phone: 541-285-0932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number04236
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: