Provider Demographics
NPI:1942572904
Name:VALENTINE, SHAWN M (DPT)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:M
Last Name:VALENTINE
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 1:5075 LYNNHAVEN PKWY
Mailing Address - Street 2:APT 307
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464
Mailing Address - Country:US
Mailing Address - Phone:607-382-5356
Mailing Address - Fax:
Practice Address - Street 1:2135 GENERAL BOOTH BLVD
Practice Address - Street 2:STE 152
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5881
Practice Address - Country:US
Practice Address - Phone:757-430-8828
Practice Address - Fax:757-430-8189
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13515225100000X
VA2305208351225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist