Provider Demographics
NPI:1760911507
Name:HERLONG, SHAWN MICHAEL (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:MICHAEL
Last Name:HERLONG
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 LONGSTONE LN STE A
Mailing Address - Street 2:
Mailing Address - City:MARRIOTTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21104-1516
Mailing Address - Country:US
Mailing Address - Phone:410-982-6251
Mailing Address - Fax:410-982-6263
Practice Address - Street 1:2470 LONGSTONE LN STE A
Practice Address - Street 2:
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1516
Practice Address - Country:US
Practice Address - Phone:410-982-6251
Practice Address - Fax:410-982-6263
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD26512OtherPHYSICAL THERAPY