Provider Demographics
NPI:1093700536
Name:SHAUF, LAWRENCE EUGENE (PT)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:EUGENE
Last Name:SHAUF
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9860 S ESTRELLA PKWY
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-7149
Mailing Address - Country:US
Mailing Address - Phone:785-424-4081
Mailing Address - Fax:
Practice Address - Street 1:9860 S ESTRELLA PKWY
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-7149
Practice Address - Country:US
Practice Address - Phone:785-424-4081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT004076E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
650020674OtherRR MEDICARE
450786OtherHIGHMARK
450786OtherHIGHMARK
R70641Medicare UPIN