Provider Demographics
NPI:1669625935
Name:GEORGE, SHANNON ROSE (PT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ROSE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 NEFF AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3495
Mailing Address - Country:US
Mailing Address - Phone:540-434-1200
Mailing Address - Fax:540-434-1203
Practice Address - Street 1:313 NEFF AVE
Practice Address - Street 2:SUITE C
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3495
Practice Address - Country:US
Practice Address - Phone:540-434-1200
Practice Address - Fax:540-434-1203
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029309-1225100000X
VA2305005847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist