Provider Demographics
NPI:1306127006
Name:SHAW, CHRISTOPHER LEIGH (PT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LEIGH
Last Name:SHAW
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-3909
Mailing Address - Country:US
Mailing Address - Phone:360-417-7728
Mailing Address - Fax:
Practice Address - Street 1:321 N CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3919
Practice Address - Country:US
Practice Address - Phone:360-417-7728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist