Individual
ELLEN SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1005 N EVERGREEN RD STE 10, SPOKANE VALLEY, WA 99216-1485
(509) 926-5367
(509) 928-5508
Mailing address
16083 SW UPPER BOONES FERRY RD STE 300, TIGARD, OR 97224-7736
(800) 219-8835
(503) 639-9699
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
60462884
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0329441
WA L&I
WA
05
—
2038544
—
WA
01
—
P01383825
RR MEDICARE PTAN
WA
Enumeration date
08/11/2014
Last updated
12/31/2014
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