Provider Demographics
NPI:1194850537
Name:DAY, SHAWTAY
Entity Type:Individual
Prefix:
First Name:SHAWTAY
Middle Name:
Last Name:DAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 PARKER ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-2874
Mailing Address - Country:US
Mailing Address - Phone:304-588-3731
Mailing Address - Fax:
Practice Address - Street 1:3 WESTERN HILLS DR
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26105-8122
Practice Address - Country:US
Practice Address - Phone:304-420-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001230225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0002106000Medicaid
WV0002106000Medicaid