Provider Demographics
NPI:1619614310
Name:CASWELL, SHANE VINCENT (ATC)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:VINCENT
Last Name:CASWELL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10900 UNIVERSITY BOULEVARD
Mailing Address - Street 2:KATHERINE JOHNSON HALL, MSN 4E5
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-2203
Mailing Address - Country:US
Mailing Address - Phone:703-993-4638
Mailing Address - Fax:703-993-2025
Practice Address - Street 1:10900 UNIVERSITY BOULEVARD
Practice Address - Street 2:KATHERINE JOHNSON HALL, MSN 4E5
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-2203
Practice Address - Country:US
Practice Address - Phone:703-993-4638
Practice Address - Fax:703-993-2025
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01260008752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer