Provider Demographics
NPI:1003802943
Name:SHAW, MICHAEL DUDLEY (MPT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DUDLEY
Last Name:SHAW
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
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Mailing Address - Street 1:725 RESERVOIR AVE
Mailing Address - Street 2:#101
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4448
Mailing Address - Country:US
Mailing Address - Phone:401-944-3800
Mailing Address - Fax:401-944-1342
Practice Address - Street 1:2138 MENDON RD
Practice Address - Street 2:#302
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-3834
Practice Address - Country:US
Practice Address - Phone:401-334-0218
Practice Address - Fax:401-334-9531
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2010-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RI01331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI405638OtherBLUECHIP
RI1003802943OtherDURABLE