IndividualActive
Dayne Shaw, PT, DPT
NPI 1053162230 · Pediatric Physical Therapist · Shelley, ID
Provider details
- NPI number
- 1053162230
- Entity type
- Individual
- Primary specialty
- Pediatric Physical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Credential
- PT, DPT
- Sex
- Male
- Sole proprietor
- Yes
- License
- PT-8769 (ID)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
650 N State St Ste 5
Shelley, ID 83274-4900
Phone: (208) 428-6079
Approximate (ZIP-level) locationGet directions
Mailing address
650 N State St Ste 5
Shelley, ID 83274-4900
Registry dates
- Enumerated
- 2024-03-27
- Last updated
- 2025-09-03
- Certified
- 2025-09-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.