Provider Demographics
NPI:1891065637
Name:SHANKMAN, GARY A (PTA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:A
Last Name:SHANKMAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:553 RIVERSTONE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5222
Mailing Address - Country:US
Mailing Address - Phone:770-345-3057
Mailing Address - Fax:770-345-3154
Practice Address - Street 1:553 RIVERSTONE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5222
Practice Address - Country:US
Practice Address - Phone:770-345-3057
Practice Address - Fax:770-345-3154
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA000098225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant