Provider Demographics
NPI:1437884947
Name:SHAW, HOLLY KRISTEN (PT)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:KRISTEN
Last Name:SHAW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17356 60TH LN N
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-3205
Mailing Address - Country:US
Mailing Address - Phone:561-509-4599
Mailing Address - Fax:561-741-1375
Practice Address - Street 1:17356 60TH LN N
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-3205
Practice Address - Country:US
Practice Address - Phone:561-509-4599
Practice Address - Fax:561-741-1375
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT18819OtherSTATE LICENSE