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General NPI Number Information
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NPI Number | 1598921553
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Entity Type | Individual
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Provider Name | JASON SHAW MPT, DA
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Gender | Male
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Dates
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Enumeration Date | 07/30/2008
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Last Update Date | 01/27/2017
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Provider Practice Location Address
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Address Line | 4542 E 280 N
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City | RIGBY
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State | ID
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Zip | 83442-5885
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Country | US
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Telephone | 208-538-7382
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 322
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City | REXBURG
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State | ID
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Zip | 83440-0322
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Country | US
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Telephone | 208-359-2500
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Fax | 208-359-2502
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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 | PT-938
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License Number State | ID
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