Individual
TRACIE LYNN SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
3612 WOODLEY RD NW, WASHINGTON, DC 20016-5033
(202) 537-5789
Mailing address
3612 WOODLEY RD NW, WASHINGTON, DC 20016-5033
(202) 537-5789
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
0126001356
VA
2255A2300X
Athletic Trainer
Primary
A00543
MD
2255A2300X
Athletic Trainer
AT9216
TX
Other
Enumeration date
07/17/2023
Last updated
07/17/2023
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