Individual
KEITH SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1250 W WHITTAKER ST, SALEM, IL 62881-1917
(618) 548-3769
Mailing address
PO BOX 503861, SAINT LOUIS, MO 63150-0001
(618) 548-3769
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
IL
Other
Enumeration date
01/04/2007
Last updated
07/08/2007
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