Provider Demographics
NPI:1962861088
Name:SHAW LIPIEC, SAMETTA (PHYSICALTHERAPIST AS)
Entity Type:Individual
Prefix:MRS
First Name:SAMETTA
Middle Name:
Last Name:SHAW LIPIEC
Suffix:
Gender:F
Credentials:PHYSICALTHERAPIST AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:NY
Mailing Address - Zip Code:13340-3714
Mailing Address - Country:US
Mailing Address - Phone:315-894-5095
Mailing Address - Fax:315-894-8762
Practice Address - Street 1:120 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:NY
Practice Address - Zip Code:13340-3714
Practice Address - Country:US
Practice Address - Phone:315-894-5095
Practice Address - Fax:315-894-8762
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006173225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant