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NPI Code Detail

MEDICARE: CLAUDE GOODMAN SHAW JR. PTA

MEDICARE: CLAUDE GOODMAN SHAW JR. PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantA2534NC

General Provider Information

NPI Number : 1053029801
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLAUDE GOODMAN SHAW JR. PTA
Provider Business Mailing Address
First Line : 6624 BROOKMEADE DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28226-7724
Country : US
Telephone Number : 980-254-3560
Fax Number :
Provider Business Practice Location Address
First Line : 5800 OLD PROVIDENCE RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28226-6872
Country : US
Telephone Number : 704-365-8551
Fax Number : 704-365-8505
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2022
Last Update Date : 11/10/2022

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