Provider Demographics
NPI:1184847618
Name:SHIELDS, PAMELA GAIL (PT)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:GAIL
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:GAIL
Other - Last Name:WENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:12779 TURBERVILLE LN
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2216
Mailing Address - Country:US
Mailing Address - Phone:937-672-1054
Mailing Address - Fax:
Practice Address - Street 1:12779 TURBERVILLE LN
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171
Practice Address - Country:US
Practice Address - Phone:571-308-8252
Practice Address - Fax:571-250-6305
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008971L2251X0800X
DCPT8719332251X0800X
VA23052095782251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111408402Medicaid
TX111408402Medicaid