Provider Demographics
NPI:1346769858
Name:SHU, RAYMOND (DPT)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:SHU
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 SHERIDAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14223
Mailing Address - Country:US
Mailing Address - Phone:716-803-8220
Mailing Address - Fax:716-874-1458
Practice Address - Street 1:2075 SHERIDAN DRIVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14223
Practice Address - Country:US
Practice Address - Phone:716-803-8220
Practice Address - Fax:716-874-1458
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-15
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0421482251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Single Specialty