Provider Demographics
NPI:1477609733
Name:SHAPOW, MORRIS (RPT)
Entity Type:Individual
Prefix:
First Name:MORRIS
Middle Name:
Last Name:SHAPOW
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5359 BALBOA BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2803
Mailing Address - Country:US
Mailing Address - Phone:818-304-0990
Mailing Address - Fax:818-304-0996
Practice Address - Street 1:5359 BALBOA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2803
Practice Address - Country:US
Practice Address - Phone:818-304-0990
Practice Address - Fax:818-304-0996
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6166225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1477609733OtherTYPE II
CAW16329Medicare ID - Type UnspecifiedMEDICARE
CAW18696Medicare ID - Type UnspecifiedMEDICARE