Healthcare Provider Details

I. General information

NPI: 1265853097
Provider Name (Legal Business Name): RYAN P SHUMATE PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 HINSON FARM RD STE 401
ALEXANDRIA VA
22306-3409
US

IV. Provider business mailing address

8101 HINSON FARM RD STE 401
ALEXANDRIA VA
22306-3409
US

V. Phone/Fax

Practice location:
  • Phone: 703-664-7660
  • Fax: 703-664-7663
Mailing address:
  • Phone: 703-664-7660
  • Fax: 703-664-7663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305208443
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: