Provider Demographics
NPI:1205047438
Name:SHAW, SARAH ANN (MPT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:SHAW
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ANN
Other - Last Name:TYNDALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPT
Mailing Address - Street 1:2627 S WARNOCK ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-4418
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2817 REILLY ROAD
Practice Address - Street 2:DEPARTMENT OF ORTHO & REHAB
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-3500
Practice Address - Country:US
Practice Address - Phone:910-907-9798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0183552251X0800X
NCP175812251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic