Provider Demographics
NPI:1194400234
Name:GRAVES, SHAWN (DPT)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:GRAVES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 12TH ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52241-3118
Mailing Address - Country:US
Mailing Address - Phone:510-837-4499
Mailing Address - Fax:
Practice Address - Street 1:3207 220TH TRL
Practice Address - Street 2:
Practice Address - City:AMANA
Practice Address - State:IA
Practice Address - Zip Code:52203-8206
Practice Address - Country:US
Practice Address - Phone:319-622-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA115957225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist