Provider Demographics
NPI:1013104082
Name:SHAW, WENDY (MPT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6211 N FELTS ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217-9667
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9212 E MONTGOMERY AVE
Practice Address - Street 2:#103
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4239
Practice Address - Country:US
Practice Address - Phone:509-922-0855
Practice Address - Fax:509-921-0050
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00105382251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics