MEDICARE: DANIEL D SHAW PT

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	PT1065	ID

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00217946	OTHER	ID	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010149920	OTHER	ID	BLUE SHIELD
2	TC233	OTHER	ID	BLUE CROSS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649260654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL D SHAW PT

Provider Business Mailing Address
First Line	:	217 W GEORGIA AVE
Second Line	:	STE 115
City	:	NAMPA
State	:	ID
Zip	:	83686-6811
Country	:	US
Telephone Number	:	208-463-3291
Fax Number	:	208-463-3044

Provider Business Practice Location Address
First Line	:	290 W GEORGIA AVE
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-2835
Country	:	US
Telephone Number	:	208-468-5970
Fax Number	:	208-463-3044

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	02/08/2010

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Directions to “ DANIEL D SHAW PT” Practice Location

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