Provider Demographics
NPI:1649602004
Name:SHAW, JOYCE SEULGIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:SEULGIE
Last Name:SHAW
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SEULGIE
Other - Middle Name:WOO
Other - Last Name:BYUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2001 S BARRINGTON AVE STE 119
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2001 S BARRINGTON AVE STE 119
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5337
Practice Address - Country:US
Practice Address - Phone:650-558-0247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT40454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist