Provider Demographics
NPI:1477879997
Name:SHAW, KEIBA LYNN (PT, EDD)
Entity Type:Individual
Prefix:DR
First Name:KEIBA
Middle Name:LYNN
Last Name:SHAW
Suffix:
Gender:F
Credentials:PT, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3632 QUEEN PALM DRIVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-2047
Mailing Address - Country:US
Mailing Address - Phone:813-574-5318
Mailing Address - Fax:
Practice Address - Street 1:3632 QUEEN PALM DRIVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-1154
Practice Address - Country:US
Practice Address - Phone:813-574-5318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT209242251G0304X
CO107262251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic