MEDICARE: MR. GARY SHAW DPT

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
1	225100000X	Physical Therapist	PT866	DC

General Provider Information

NPI Number	:	1477689529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY SHAW DPT

Provider Business Mailing Address
First Line	:	3218 18TH ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20010-1002
Country	:	US
Telephone Number	:	202-359-7685
Fax Number	:	202-359-7685

Provider Business Practice Location Address
First Line	:	3218 18TH ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20010-1002
Country	:	US
Telephone Number	:	202-359-7685
Fax Number	:	202-359-7685

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2007
Last Update Date	:	07/08/2007

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