Provider Demographics
NPI:1861800930
Name:SHAW, MEGHAN (DPT)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 ORCHARD ST W
Mailing Address - Street 2:STE. 100
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6606
Mailing Address - Country:US
Mailing Address - Phone:253-564-1560
Mailing Address - Fax:253-564-4449
Practice Address - Street 1:451 SW SEDGWICK RD
Practice Address - Street 2:STE. 310
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-6447
Practice Address - Country:US
Practice Address - Phone:360-874-8009
Practice Address - Fax:360-874-8010
Is Sole Proprietor?:No
Enumeration Date:2014-08-01
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10134225100000X
WAPT60588021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8947872Medicare PIN
WAG8947871Medicare PIN