Provider Demographics
NPI:1508998436
Name:SHAPIRO, CHARLES MICHAEL (PT)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MICHAEL
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3634
Mailing Address - Country:US
Mailing Address - Phone:954-989-5255
Mailing Address - Fax:954-962-6445
Practice Address - Street 1:3850 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3634
Practice Address - Country:US
Practice Address - Phone:954-989-5255
Practice Address - Fax:954-962-6445
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0002021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT0002021OtherFL PT LICENSE
FLPT0002021OtherFL PT LICENSE