Provider Demographics
NPI:1205574951
Name:SHAPIRO GIMPEL, AUDREY BETH (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:BETH
Last Name:SHAPIRO GIMPEL
Suffix:
Gender:F
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 1:5247 CORTEEN PL APT 209
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-4248
Mailing Address - Country:US
Mailing Address - Phone:323-528-7899
Mailing Address - Fax:
Practice Address - Street 1:5247 CORTEEN PL APT 209
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-4248
Practice Address - Country:US
Practice Address - Phone:323-528-7899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54736225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist