Provider Demographics
NPI:1003906793
Name:SHASBY, GREGORY B (PHD, PT)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:B
Last Name:SHASBY
Suffix:
Gender:M
Credentials:PHD, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 PILOT HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1990
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:10128 W BROAD ST
Practice Address - Street 2:FORUM BLDG III, SUITE K
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6761
Practice Address - Country:US
Practice Address - Phone:804-217-9210
Practice Address - Fax:804-217-9213
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004092208100000X
VA2305205897225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA342327OtherBCBS (PHYSICAL THERAPY)
KYP00217523OtherTRAVELERS MEDICARE ID
VAP00930518OtherRAILROAD MEDICARE
7263602OtherAETNA PROVIDER ID
KY000000331732OtherANTHEM BCBS PROVIDER ID
VA1003906793Medicaid
KY000000331732OtherANTHEM BCBS PROVIDER ID
VAP00930518OtherRAILROAD MEDICARE
VA342327OtherBCBS (PHYSICAL THERAPY)
VAC05954Medicare PIN