Provider Demographics
NPI:1770821100
Name:SHAW, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 MCCARRAN ST. APT. 1027
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:UT
Mailing Address - Zip Code:89081-8117
Mailing Address - Country:US
Mailing Address - Phone:801-633-6490
Mailing Address - Fax:
Practice Address - Street 1:6300 MCCARRAN ST UNIT 1027
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-8134
Practice Address - Country:US
Practice Address - Phone:801-633-6490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT835135824012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic