Provider Demographics
NPI:1700251477
Name:DAUGHERTY, SHANA SHERMAN (PT, DPT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:SHERMAN
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:PT, DPT, LAT, ATC
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:KATHLEEN
Other - Last Name:SHERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, LAT, ATC
Mailing Address - Street 1:19376 PINELAND ACRES LN
Mailing Address - Street 2:
Mailing Address - City:BROADWAY
Mailing Address - State:VA
Mailing Address - Zip Code:22815-2017
Mailing Address - Country:US
Mailing Address - Phone:540-271-4616
Mailing Address - Fax:
Practice Address - Street 1:13892 TIMBER WAY
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:VA
Practice Address - Zip Code:22815-3332
Practice Address - Country:US
Practice Address - Phone:540-901-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260023892255A2300X
VA2305213828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer