Healthcare Provider Details

I. General information

NPI: 1013104082
Provider Name (Legal Business Name): WENDY SHAW MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9212 E MONTGOMERY AVE #103
SPOKANE VALLEY WA
99206-4239
US

IV. Provider business mailing address

6211 N FELTS ST
SPOKANE WA
99217-9667
US

V. Phone/Fax

Practice location:
  • Phone: 509-922-0855
  • Fax: 509-921-0050
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT0010538
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: