Individual
MRS. JESSICA LORI SHAW
Active
Individual
MRS. JESSICA LORI SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6258
TN
225100000X
Physical Therapist
PT007002
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4021800
BCBS
TN
01
—
TN0100
JOHN DEERE
TN
Enumeration date
06/22/2005
Last updated
10/30/2007
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