Justin Tyler Shaw, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT7790 Issued in TX

Practice address

368 N Greenville Ave
Allen, TX 75002-2232

Phone

(972) 396-6975

NPI assigned

Mar 8, 2018

Last updated

Oct 14, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1520467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602633600000",
    "number": "1376045054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6802 AMESBURY LN",
            "city": "ROWLETT",
            "state": "TX",
            "postal_code": "750893803",
            "telephone_number": "972-922-4991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "368 N GREENVILLE AVE",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "750022232",
            "telephone_number": "972-396-6975"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 S Nedderman Dr",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "TX",
            "postal_code": "760199800",
            "country_code": "US",
            "telephone_number": "817-272-2011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAW",
        "first_name": "JUSTIN",
        "middle_name": "TYLER",
        "credential": "LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-08",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TX",
            "license": "AT7790",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bridget Ann Shannon, OD
• Aatifa Shareef
• Sharone Overfelt Counseling
• Nikita Shastri, DPT
• Bethany Shaw
• Courtne Shed, PT, DPT
• Misty Lyn Shedd, NP
• Philip James Sheedy, PT, DPT
• Kathleen Shelffo, OTA
• Yun Shen, PT

• Athletic Trainer in Allen, TX
• Providers in Allen, TX by specialty
• Athletic Trainer in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.