Provider Demographics
NPI:1295280246
Name:PAMINTUAN, SHAUN (DPT)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:PAMINTUAN
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 BROADWAY
Mailing Address - Street 2:2ND FLOOR #805
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-2562
Mailing Address - Country:US
Mailing Address - Phone:562-607-7303
Mailing Address - Fax:
Practice Address - Street 1:28 FROST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-1203
Practice Address - Country:US
Practice Address - Phone:347-201-0598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ4WFH1Medicare PIN