Provider Demographics
NPI:1477689529
Name:SHAW, GARY (DPT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:SHAW
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 18TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-1002
Mailing Address - Country:US
Mailing Address - Phone:202-359-7685
Mailing Address - Fax:202-359-7685
Practice Address - Street 1:3218 18TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-1002
Practice Address - Country:US
Practice Address - Phone:202-359-7685
Practice Address - Fax:202-359-7685
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist