Provider Demographics
NPI:1831147644
Name:SHAW, SCOTT JAMES (ATC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:JAMES
Last Name:SHAW
Suffix:
Gender:M
Credentials:ATC
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Mailing Address - Street 1:17340 BURBANK BLVD
Mailing Address - Street 2:#205
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1754
Mailing Address - Country:US
Mailing Address - Phone:818-981-3720
Mailing Address - Fax:818-677-7516
Practice Address - Street 1:18111 NORDHOFF ST.
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91330-8276
Practice Address - Country:US
Practice Address - Phone:818-677-3237
Practice Address - Fax:818-677-7516
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer