Provider Demographics
NPI:1548597750
Name:ROSENGRANT, SHAWN R (DPT)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:R
Last Name:ROSENGRANT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 FIRST COLONIAL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3171
Mailing Address - Country:US
Mailing Address - Phone:757-226-0075
Mailing Address - Fax:757-412-1015
Practice Address - Street 1:968 FIRST COLONIAL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3171
Practice Address - Country:US
Practice Address - Phone:757-226-0075
Practice Address - Fax:757-412-1015
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205956225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA022291G72Medicare PIN