=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902081870
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLYN LAWING SHAW PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2008
-----------------------------------------------------
Last Update Date | 05/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 815 W HAMLET AVE WHISTLE STOP SQUARE
-----------------------------------------------------
City | HAMLET
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28345-2507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-582-7046
-----------------------------------------------------
Fax | 910-582-7106
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5061 WOODRUN ON TILLERY
-----------------------------------------------------
City | MOUNT GILEAD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27306-9541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-439-5056
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251P0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Physical Therapist
-----------------------------------------------------
License Number | 667
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------