Provider Demographics
NPI:1083208292
Name:SHAMO, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SHAMO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 STRATHMORE CT
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4001
Mailing Address - Country:US
Mailing Address - Phone:847-997-6880
Mailing Address - Fax:
Practice Address - Street 1:212 EASTGATE CT
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-3003
Practice Address - Country:US
Practice Address - Phone:847-458-0102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant