Healthcare Provider Details

I. General information

NPI: 1689996720
Provider Name (Legal Business Name): SHIRLEY GAW RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2010
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7975 W SAHARA AVE
LAS VEGAS NV
89117-7942
US

IV. Provider business mailing address

7975 W SAHARA AVE
LAS VEGAS NV
89117-7942
US

V. Phone/Fax

Practice location:
  • Phone: 702-617-4470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT - 1958
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License NumberPT - 1958
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License NumberPT - 1958
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License NumberPT - 1958
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT - 1958
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT - 1958
License Number StateNV
# 7
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT - 1958
License Number StateNV
# 8
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT - 1958
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: