Provider Demographics
NPI:1861824625
Name:SHAW, CAITLIN (DPT)
Entity Type:Individual
Prefix:MISS
First Name:CAITLIN
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-1439
Mailing Address - Country:US
Mailing Address - Phone:908-489-4700
Mailing Address - Fax:
Practice Address - Street 1:2129 W OREGON AVE
Practice Address - Street 2:3RD FLOOR SUITE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-4131
Practice Address - Country:US
Practice Address - Phone:215-336-6630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist