Provider Demographics
NPI:1740619766
Name:WRIGHT, SHAVON D (DPT)
Entity type:Individual
Prefix:
First Name:SHAVON
Middle Name:D
Last Name:WRIGHT
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:SHAVON
Other - Middle Name:D
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:748 MURAL LAKE CT
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-5963
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12101 CAROL LN
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6101
Practice Address - Country:US
Practice Address - Phone:540-785-7617
Practice Address - Fax:540-786-8620
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24745225100000X
VA2305207820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist