Provider Demographics
NPI:1477515559
Name:SHEN, RICHARD (DPT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:SHEN
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 1:388 E OCEAN BLVD
Mailing Address - Street 2:#305
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-5252
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:388 E OCEAN BLVD
Practice Address - Street 2:#305
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-5252
Practice Address - Country:US
Practice Address - Phone:310-800-7436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist