Provider Demographics
NPI:1720348717
Name:SHIMA, DANIELLE (PTA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:SHIMA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23117 RANCHO PEAK PL
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-3229
Mailing Address - Country:US
Mailing Address - Phone:951-704-9553
Mailing Address - Fax:
Practice Address - Street 1:23117 RANCHO PEAK PL
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-3229
Practice Address - Country:US
Practice Address - Phone:951-704-9553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT3879225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant