Provider Demographics
NPI:1093837544
Name:SHUTES, RICHARD WARREN (PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:WARREN
Last Name:SHUTES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2584 NEWFOUND HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-2869
Mailing Address - Country:US
Mailing Address - Phone:321-454-9194
Mailing Address - Fax:888-726-9309
Practice Address - Street 1:2620 SE MARICAMP RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5582
Practice Address - Country:US
Practice Address - Phone:352-351-8883
Practice Address - Fax:352-351-4219
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0004278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist