Provider Demographics
NPI:1336717735
Name:PASCUCCI, SHELBY RENEE (DPT)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:RENEE
Last Name:PASCUCCI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 RENEAU WAY APT 1C
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4515
Mailing Address - Country:US
Mailing Address - Phone:703-626-9379
Mailing Address - Fax:
Practice Address - Street 1:3299 WOODBURN RD STE 310
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-7300
Practice Address - Country:US
Practice Address - Phone:703-849-8142
Practice Address - Fax:703-849-0735
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist