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General NPI Number Information
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NPI Number | 1104063775
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Entity Type | Organization
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Legal Business Name | SHAW ENTERPRISES
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Dates
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Enumeration Date | 01/19/2009
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Last Update Date | 01/19/2009
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Provider Practice Location Address
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Address Line | 401 RIO RANCHO WAY
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City | BRIGHTON
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State | CO
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Zip | 80601-3539
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Country | US
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Telephone | 303-514-9912
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Fax |
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Provider Business Mailing Address
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Address Line | 401 RIO RANCHO WAY
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City | BRIGHTON
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State | CO
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Zip | 80601-3539
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Country | US
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Telephone | 303-514-9912
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Fax |
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Authorized Official
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Title or Position | GEN PTR
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Name | JOHNELLE NUSPL SHAW
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Credential | PT, MSPT, DPT
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Telephone | 303-514-9912
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 8650
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License Number State | CO
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