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1912215906
PHILLIP ALLEN SHAW
MONROE, LA
NPI
1912215906
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: LA J00150)
Enumeration Date
2010-09-23
Last Update Date
2018-11-10
Business Address
PHILLIP ALLEN SHAW M.Ed., A.T.C.
681 HIGHWAY 594
MONROE, LA 71203-8900
Phone number: 318-381-0140
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Mailing Address
PHILLIP ALLEN SHAW M.Ed., A.T.C.
103 OAK TRL
MONROE, LA 71203-9672
Phone number: 318-381-0140
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