Individual
PHILLIP ALLEN SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.ED., A.T.C.
Contact information
Practice address
681 HIGHWAY 594, MONROE, LA 71203-8900
(318) 381-0140
Mailing address
103 OAK TRL, MONROE, LA 71203-9672
(318) 381-0140
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
J00150
LA
Other
Enumeration date
09/23/2010
Last updated
11/10/2018
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