Provider Demographics
NPI:1497758403
Name:SHAW, DESIREE M (PT, MPT)
Entity Type:Individual
Prefix:MS
First Name:DESIREE
Middle Name:M
Last Name:SHAW
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4674 SNOW MESA DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8615
Mailing Address - Country:US
Mailing Address - Phone:970-266-3850
Mailing Address - Fax:970-266-3855
Practice Address - Street 1:4674 SNOW MESA DR
Practice Address - Street 2:SUITE 140
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8615
Practice Address - Country:US
Practice Address - Phone:970-266-3850
Practice Address - Fax:970-266-3855
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3711225100000X
CO3393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist