AMANDA SHAW – Physical Therapist, NPI 1104653195

AMANDA SHAW is a healthcare provider. based in Mountain home, Arkansas. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. They hold a License No. PT5239 (AR). The NPI Number for AMANDA SHAW is 1104653195

Main info

Female
4 Years Of Experience
Accepts Medicare Assignment
Name
AMANDA SHAW
NPI
1104653195
Phone
(870) 701-5089
Address
PO BOX 2398
Enumeration Date
16 September 2024
Last Update Date
19 December 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8702481119
Graduation Year
2022 (4 years ago)
PAC ID
8820589948
Group Practice PAC ID
5991072050
Professional Enrollment ID
I20260126000327
Address ID
AR724551203PO2520XRDXX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience26
Completeness85
Years active:1State licenses:1Digital endpointsOther names

838 PHYSICAL THERAPIST IN PRIVATE PRACTICE in AR

Provider Addresses for AMANDA SHAW

  • PO BOX 2398

    MOUNTAIN HOME, AR 726542398

    Phone: (870) 701-5089

    Fax: (870) 277-0896

    Type: Mailing

  • 2520 THOMASVILLE RD

    POCAHONTAS, AR 724551203

    Phone: (870) 248-1119

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2026-01-26

PECOS data refreshed: 2026-06-15

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20260126000327IPhysical Therapist In Private PracticeARTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 72654)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 5991072050View full group profile
NameSpecialtyState
Physical Therapist In Private PracticeAR
Physical Therapist In Private PracticeAR
Physical Therapist In Private PracticeAR
Physical Therapist In Private PracticeAR
Physical Therapist In Private PracticeAL
Occupational Therapist In Private PracticeAR
Physical Therapist In Private PracticeAR
Physical Therapist In Private PracticeAR
Occupational Therapist In Private PracticeAR
Occupational Therapist In Private PracticeAR

Reviews

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Frequently asked questions

What unique ID ties claims to AMANDA SHAW?
NPI 1104653195 is assigned to AMANDA SHAW under the national enumeration system.
Is AMANDA SHAW active in the national directory?
AMANDA SHAW's public NPI profile is in an active state.
Can you summarize AMANDA SHAW's specialty in plain language?
Clinically, the directory lists AMANDA SHAW with Physical Therapist. Clinical services aligned with this taxonomy classification.
What location shows for AMANDA SHAW?
We surface Mountain Home, Arkansas for AMANDA SHAW based on available NPPES addresses.
How can I contact AMANDA SHAW?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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