Provider Demographics
NPI:1952388993
Name:GARLAND, SHANA D (PT ATC)
Entity Type:Individual
Prefix:MS
First Name:SHANA
Middle Name:D
Last Name:GARLAND
Suffix:
Gender:F
Credentials:PT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 DIAMOND PLUM CIRCLE
Mailing Address - Street 2:APT 302
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452
Mailing Address - Country:US
Mailing Address - Phone:757-274-7111
Mailing Address - Fax:
Practice Address - Street 1:397 LITTLE NECK RD
Practice Address - Street 2:BLDG 3000 DYNAMIC HEALTH SERVICES
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452
Practice Address - Country:US
Practice Address - Phone:757-639-3153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203825225100000X
VA01260008552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA105915OtherANTHEM BCBS
004490M47Medicare ID - Type Unspecified