Provider Demographics
NPI:1841513124
Name:SHAW, VERONICA JO (ATC)
Entity type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:JO
Last Name:SHAW
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:VERONICA
Other - Middle Name:JO
Other - Last Name:SERNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:1326 W HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2700
Mailing Address - Country:US
Mailing Address - Phone:802-136-1534
Mailing Address - Fax:
Practice Address - Street 1:1326 W HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2700
Practice Address - Country:US
Practice Address - Phone:802-136-1534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0791026152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer