Provider Demographics
NPI:1558739102
Name:SHOEMAKER, PAUL CHARLES (PT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:CHARLES
Last Name:SHOEMAKER
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 1:3350 AMHERST WAY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-9297
Mailing Address - Country:US
Mailing Address - Phone:541-285-0932
Mailing Address - Fax:
Practice Address - Street 1:3500 HILYARD ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3867
Practice Address - Country:US
Practice Address - Phone:541-687-9211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR04236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist