Provider Demographics
NPI:1902779325
Name:SHAW, DANIELLE (PTA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 MILLAN TRL
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-8406
Mailing Address - Country:US
Mailing Address - Phone:502-222-9441
Mailing Address - Fax:
Practice Address - Street 1:3001 W HIGHWAY 146
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9123
Practice Address - Country:US
Practice Address - Phone:502-222-9441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06004635A225200000X
KYA02773225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant