Provider Demographics
NPI:1992502983
Name:SHAW, RILEY (PT, DPT)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:SHAW
Suffix:
Gender:
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 1:1425 UNIONVILLE DEASON RD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-5628
Mailing Address - Country:US
Mailing Address - Phone:309-333-0653
Mailing Address - Fax:
Practice Address - Street 1:190D SAUNDERSVILLE RD STE 2002
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-1008
Practice Address - Country:US
Practice Address - Phone:615-669-4043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16260225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist