Provider Demographics
NPI:1326250200
Name:SHIMMEL, JENNY POULIN (MS,PT)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:POULIN
Last Name:SHIMMEL
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:CLAIRE
Other - Last Name:POULIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PT
Mailing Address - Street 1:805 W RIVER HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3123
Mailing Address - Country:US
Mailing Address - Phone:813-368-1645
Mailing Address - Fax:
Practice Address - Street 1:805 W RIVER HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3123
Practice Address - Country:US
Practice Address - Phone:813-368-1645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 16130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist