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General NPI Number Information
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NPI Number | 1619254489
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Entity Type | Individual
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Provider Name | JOHN ERIC SHAW P.T.
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Gender | Male
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Dates
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Enumeration Date | 11/08/2011
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Last Update Date | 11/08/2011
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Provider Practice Location Address
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Address Line | 500 MARKET ST
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City | GRAFTON
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State | WV
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Zip | 26354-1184
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Country | US
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Telephone | 304-265-2191
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Fax | 304-265-2194
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Provider Business Mailing Address
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Address Line | 500 MARKET ST
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City | GRAFTON
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State | WV
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Zip | 26354-1184
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Country | US
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Telephone | 304-265-2191
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Fax | 304-265-2194
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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 | 1157
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License Number State | WV
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