Provider Demographics
NPI:1972899763
Name:SHENK, NICOLE E (PT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:E
Last Name:SHENK
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 1:4040 FAIRFAX DR STE 120
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1613
Mailing Address - Country:US
Mailing Address - Phone:703-292-4060
Mailing Address - Fax:703-292-4066
Practice Address - Street 1:4040 FAIRFAX DR STE 120
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1613
Practice Address - Country:US
Practice Address - Phone:703-292-4060
Practice Address - Fax:703-292-4066
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23670225100000X
VA2305207352225100000X
DC871780225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist