Provider Demographics
NPI:1861065013
Name:SHAW, NEIL FRANCIS (DPT)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:FRANCIS
Last Name:SHAW
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2718 US HIGHWAY 52 W STE C
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-5529
Practice Address - Country:US
Practice Address - Phone:765-237-3508
Practice Address - Fax:765-250-4989
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1346973225100000X
OHPT019373225100000X
IN225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist