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General NPI Number Information
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NPI Number | 1013654649
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Entity Type | Individual
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Provider Name | STEPHANIE SHIMODA DPT
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Gender | Female
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Dates
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Enumeration Date | 05/16/2022
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 300 M ST SE UNIT 104
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City | WASHINGTON
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State | DC
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Zip | 20003-3400
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Country | US
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Telephone | 202-221-8250
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Fax | 202-221-8251
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Provider Business Mailing Address
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Address Line | 21096 SADDLEBACK CIR
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City | PARKER
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State | CO
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Zip | 80138-7143
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 302111
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT03658
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305215540
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0018563
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License Number State | CO
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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT210002350
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License Number State | DC
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