Healthcare Provider Details

I. General information

NPI: 1992761605
Provider Name (Legal Business Name): CINDY ANN SHAW PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3093 S HARBOR BLVD
SANTA ANA CA
92704-6448
US

IV. Provider business mailing address

3093 S HARBOR BLVD
SANTA ANA CA
92704-6448
US

V. Phone/Fax

Practice location:
  • Phone: 714-546-0811
  • Fax: 714-546-3811
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT10271
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: