Provider Demographics
NPI:1134239726
Name:SHIMONI, TAL
Entity type:Individual
Prefix:
First Name:TAL
Middle Name:
Last Name:SHIMONI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5376 SW 38TH WAY
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-8225
Mailing Address - Country:US
Mailing Address - Phone:754-422-2638
Mailing Address - Fax:
Practice Address - Street 1:600 S PINE ISLAND RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3166
Practice Address - Country:US
Practice Address - Phone:954-473-6344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
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
CAPT 21206OtherLICENSE #