Provider Demographics
NPI:1245586270
Name:SHAW, CLAYTON TOWNER (PT)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:TOWNER
Last Name:SHAW
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 1:337 W IOWA AVENUE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686
Mailing Address - Country:US
Mailing Address - Phone:208-467-7889
Mailing Address - Fax:208-467-7800
Practice Address - Street 1:64 S STAR RD
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:ID
Practice Address - Zip Code:83669-5497
Practice Address - Country:US
Practice Address - Phone:208-268-0089
Practice Address - Fax:208-488-4248
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11751225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist