Provider Demographics
NPI:1225466600
Name:SHAW, LAURIE (LMT, MMP)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3085 LINE ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29153-8107
Mailing Address - Country:US
Mailing Address - Phone:940-923-4813
Mailing Address - Fax:
Practice Address - Street 1:3085 LINE ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29153-8107
Practice Address - Country:US
Practice Address - Phone:940-923-4813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7570225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist