Individual
HEATHER DENISE SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
601 N BRIARCLIFF DR, APPLETON, WI 54915-2959
(920) 739-4466
Mailing address
601 N BRIARCLIFF DR, APPLETON, WI 54915-2959
(920) 739-4466
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
536019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
56019
—
WI
Enumeration date
10/12/2009
Last updated
10/12/2009
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