Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | PT21622 | FL |
N | 2251X0800X | Physical Therapist - Orthopedic | PT21622 | FL |
NPI | 1073734331 |
---|---|
Provider Name | Mr. Adam Shaw SR. |
First Address | Apopka, FL 32703-4223 |
Second Address | Ocoee, FL 34761-6918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |