Provider Demographics
NPI:1053716928
Name:SHIMOKAWA, JOSE L (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
Last Name:SHIMOKAWA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 GILLESPIE WAY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-0917
Mailing Address - Country:US
Mailing Address - Phone:619-749-2665
Mailing Address - Fax:619-312-2637
Practice Address - Street 1:1810 GILLESPIE WAY
Practice Address - Street 2:SUITE 207
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-0917
Practice Address - Country:US
Practice Address - Phone:619-749-2665
Practice Address - Fax:619-312-2637
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist