Provider Demographics
NPI:1467234773
Name:SHAW, KIARA SYMONE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KIARA
Middle Name:SYMONE
Last Name:SHAW
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 E WILLIAMS FIELD RD APT 3012
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-5712
Mailing Address - Country:US
Mailing Address - Phone:614-483-3702
Mailing Address - Fax:
Practice Address - Street 1:5656 S POWER RD STE 139
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-8490
Practice Address - Country:US
Practice Address - Phone:480-272-7797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic