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General NPI Number Information
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NPI Number | 1396383154
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Entity Type | Individual
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Provider Name | TIMOTHY JAMES SHUTES SR. PT
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Gender | Male
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Dates
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Enumeration Date | 12/11/2019
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Last Update Date | 12/11/2019
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Provider Practice Location Address
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Address Line | 901 45TH ST
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City | MANGONIA PARK
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State | FL
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Zip | 33407-2413
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Country | US
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Telephone | 561-844-7878
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Fax |
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Provider Business Mailing Address
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Address Line | 10393 SE COCONUT LN
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City | HOBE SOUND
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State | FL
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Zip | 33455-4215
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Country | US
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Telephone | 561-827-2863
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT3592
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License Number State | FL
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