Provider Demographics
NPI:1932383122
Name:SHAW, ROBIN (PT)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1979 LAKESIDE PKWY
Mailing Address - Street 2:SUITE 800
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5935
Mailing Address - Country:US
Mailing Address - Phone:770-225-3198
Mailing Address - Fax:866-360-5109
Practice Address - Street 1:76 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02835-1005
Practice Address - Country:US
Practice Address - Phone:401-423-7020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI02128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist