Provider Demographics
NPI:1487625570
Name:SHAW, TODD B (LPT)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:B
Last Name:SHAW
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 836 BOX 361
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09636
Mailing Address - Country:IT
Mailing Address - Phone:011-390-9556
Mailing Address - Fax:0113909-556-4533
Practice Address - Street 1:PSC 836 BOX 361
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09636
Practice Address - Country:IT
Practice Address - Phone:011-390-9556
Practice Address - Fax:0113909-556-4533
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT003707225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist