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General NPI Number Information
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NPI Number | 1053543959
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Entity Type | Individual
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Provider Name | GABRIELA SHAW
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Gender | Female
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Dates
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Enumeration Date | 08/12/2009
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Last Update Date | 05/19/2015
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Provider Practice Location Address
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Address Line | 6 1/2 N 2ND AVE SUITE 303
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City | WALLA WALLA
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State | WA
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Zip | 99362-1855
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Country | US
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Telephone | 509-200-1274
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Fax |
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Provider Business Mailing Address
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Address Line | 3 MICHAEL GROVE AVE
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City | BOZEMAN
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State | MT
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Zip | 59718-1849
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Country | US
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Telephone | 509-200-1274
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00023712
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License Number State | WA
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