Provider Demographics
NPI:1689304461
Name:SHIGEMASA, MAILE CHIEMI (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MAILE
Middle Name:CHIEMI
Last Name:SHIGEMASA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 W 109TH ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-2215
Mailing Address - Country:US
Mailing Address - Phone:808-721-5785
Mailing Address - Fax:
Practice Address - Street 1:120 W 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2473
Practice Address - Country:US
Practice Address - Phone:212-320-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist