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General NPI Number Information
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NPI Number | 1548775786
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Entity Type | Individual
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Provider Name | HOLLY ANN SHAW PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 12/11/2017
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 190 SOUTHPARK CIRCLE E SUITE 102
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City | ST. AUGUSTINE
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State | FL
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Zip | 32086
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Country | US
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Telephone | 904-797-2334
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Fax |
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Provider Business Mailing Address
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Address Line | 301 LOLLY LN
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City | JACKSONVILLE
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State | FL
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Zip | 32259-4362
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Country | US
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Telephone | 904-710-8692
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT33187
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License Number State | FL
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