Provider Demographics
NPI:1316639370
Name:SHAW, DAVID (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:SHAW
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 S KITTREDGE ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-4011
Mailing Address - Country:US
Mailing Address - Phone:818-391-9438
Mailing Address - Fax:
Practice Address - Street 1:5184 S BROADWAY
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113
Practice Address - Country:US
Practice Address - Phone:720-372-0865
Practice Address - Fax:720-386-3392
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251S0007X, 2251X0800X
COPTL.0019128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic