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General NPI Number Information
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NPI Number | 1316545684
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Entity Type | Individual
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Provider Name | ZACHARY SHAMPAIN PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 10/09/2020
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 2495 TRUXTUN RD STE 200
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City | SAN DIEGO
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State | CA
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Zip | 92106-6159
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Country | US
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Telephone | 858-755-5200
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Fax | 619-223-2307
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Provider Business Mailing Address
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Address Line | 307 5TH AVE FL 6
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City | NEW YORK
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State | NY
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Zip | 10016-6575
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Country | US
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Telephone | 212-759-2282
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Fax | 212-379-2123
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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 | 046232
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License Number State | NY
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