Provider Demographics
NPI:1558303552
Name:SHUMATE, ROBERT (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SHUMATE
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 1:11700 MUKILTEO SPEEDWAY
Mailing Address - Street 2:SUITE 503
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5432
Mailing Address - Country:US
Mailing Address - Phone:425-349-9692
Mailing Address - Fax:425-349-9694
Practice Address - Street 1:11700 MUKILTEO SPEEDWAY
Practice Address - Street 2:SUITE 503
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5432
Practice Address - Country:US
Practice Address - Phone:425-349-9692
Practice Address - Fax:425-349-9694
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8904846OtherCRIME VICTIMS
WA8342156Medicaid
WA0195095OtherLABOR & INDUSTRY
WA5305SHOtherREGENCE RIDER #
WA911745305-98275-A012OtherTRICARE
WA8342156OtherDSHS
WA7322199OtherAETNA
WAP00317846OtherRR MEDICARE
WA911745305-98275-A012OtherTRICARE
WA5305SHOtherREGENCE RIDER #