Provider Demographics
NPI:1992761605
Name:SHAW, CINDY ANN (PT)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:ANN
Last Name:SHAW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3093 S HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6448
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3093 S HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6448
Practice Address - Country:US
Practice Address - Phone:714-546-0811
Practice Address - Fax:714-546-3811
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1902017411(A)OtherTYPE 2NPI
CAW14547Medicare PIN
WPT10271AMedicare ID - Type Unspecified
CA1902017411(A)OtherTYPE 2NPI