Provider Demographics
NPI:1487791554
Name:SHUTE, PAUL MICHAEL (MSPT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MICHAEL
Last Name:SHUTE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-4722
Mailing Address - Country:US
Mailing Address - Phone:302-656-2521
Mailing Address - Fax:302-656-2620
Practice Address - Street 1:1600 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-4722
Practice Address - Country:US
Practice Address - Phone:302-656-2521
Practice Address - Fax:302-656-2620
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10000998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1477538759Medicare ID - Type Unspecified