Individual
DANIEL D SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
290 W GEORGIA AVE, NAMPA, ID 83686-2835
(208) 468-5970
(208) 463-3044
Mailing address
217 W GEORGIA AVE, STE 115, NAMPA, ID 83686-6811
(208) 463-3291
(208) 463-3044
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1065
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010149920
BLUE SHIELD
ID
05
—
807145100
—
ID
01
—
P00217946
RAILROAD MEDICARE
ID
01
—
TC233
BLUE CROSS
ID
Enumeration date
10/21/2005
Last updated
02/08/2010
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