Provider Demographics
NPI:1952542573
Name:GROSS, SHAYNA B (PT)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:B
Last Name:GROSS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 PENWYN RD
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-1307
Mailing Address - Country:US
Mailing Address - Phone:609-350-3864
Mailing Address - Fax:877-407-3422
Practice Address - Street 1:406 PENWYN RD
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-1307
Practice Address - Country:US
Practice Address - Phone:609-350-3864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01306200225100000X
PAPT025756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist