Provider Demographics
NPI:1548775786
Name:SHAW, HOLLY ANN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:ANN
Last Name:SHAW
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LOLLY LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4362
Mailing Address - Country:US
Mailing Address - Phone:904-710-8692
Mailing Address - Fax:
Practice Address - Street 1:190 SOUTHPARK CIRCLE E
Practice Address - Street 2:SUITE 102
Practice Address - City:ST. AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086
Practice Address - Country:US
Practice Address - Phone:904-797-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist