MEDICARE: BETTY M. SHAW PT,OCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT13465	CA

General Provider Information

NPI Number	:	1306931746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTY M. SHAW PT,OCS

Provider Business Mailing Address
First Line	:	1303 W 6TH ST
Second Line	:	SUITE 104
City	:	CORONA
State	:	CA
Zip	:	92882-3196
Country	:	US
Telephone Number	:	951-273-7742
Fax Number	:	951-273-7747

Provider Business Practice Location Address
First Line	:	1303 W 6TH ST
Second Line	:	SUITE 104
City	:	CORONA
State	:	CA
Zip	:	92882-3196
Country	:	US
Telephone Number	:	951-273-7742
Fax Number	:	951-273-7747

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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