Provider Demographics
NPI:1649012790
Name:SHIN, HYOMIN (DPT)
Entity type:Individual
Prefix:
First Name:HYOMIN
Middle Name:
Last Name:SHIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 BLACKMON DR APT 5116
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6271
Mailing Address - Country:US
Mailing Address - Phone:470-825-1062
Mailing Address - Fax:
Practice Address - Street 1:2550 BLACKMON DR APT 5116
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6271
Practice Address - Country:US
Practice Address - Phone:470-825-1062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT017131225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist