Provider Demographics
NPI:1053971929
Name:SHAW, ZOE (LMT)
Entity type:Individual
Prefix:
First Name:ZOE
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 29TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4810
Mailing Address - Country:US
Mailing Address - Phone:206-250-2648
Mailing Address - Fax:
Practice Address - Street 1:2004 E UNION ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2836
Practice Address - Country:US
Practice Address - Phone:206-853-1540
Practice Address - Fax:206-260-7900
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60959762225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist