Provider Demographics
NPI:1285825323
Name:SHAW, CORY R (PT)
Entity Type:Individual
Prefix:MR
First Name:CORY
Middle Name:R
Last Name:SHAW
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:336 BLOOMFIELD ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3271
Mailing Address - Country:US
Mailing Address - Phone:814-269-2224
Mailing Address - Fax:814-269-4587
Practice Address - Street 1:336 BLOOMFIELD ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3271
Practice Address - Country:US
Practice Address - Phone:814-269-2224
Practice Address - Fax:814-269-4587
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017524225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist