Provider Demographics
NPI:1700514023
Name:SHIMKETS, SHAWN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:SHIMKETS
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 MARLYNN CT
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-6621
Mailing Address - Country:US
Mailing Address - Phone:858-382-0540
Mailing Address - Fax:
Practice Address - Street 1:420 MARLYNN CT
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-6621
Practice Address - Country:US
Practice Address - Phone:858-382-0540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-13
Last Update Date:2022-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90214225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist