Provider Demographics
NPI:1265853097
Name:SHUMATE, RYAN P (PT, DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:P
Last Name:SHUMATE
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 1:8101 HINSON FARM RD STE 401
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3409
Mailing Address - Country:US
Mailing Address - Phone:703-664-7660
Mailing Address - Fax:703-664-7663
Practice Address - Street 1:8101 HINSON FARM RD STE 401
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3409
Practice Address - Country:US
Practice Address - Phone:703-664-7660
Practice Address - Fax:703-664-7663
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208443225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05954OtherMEDICARE GROUP PTAN
VA1265853097OtherMEDICAID QMB ONLY
VAC05954OtherMEDICARE GROUP PTAN