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Individual

DAYNE F SHAW

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PT, DPT

Contact information

Practice address
650 N STATE ST STE 5, SHELLEY, ID 83274-4900
(208) 428-6079
Mailing address
650 N STATE ST STE 5, SHELLEY, ID 83274-4900
(208) 428-6079

Taxonomy

Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT-8769
ID

Other

Enumeration date
03/27/2024
Last updated
09/03/2025
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