Healthcare Provider Details

I. General information

NPI: 1477668788
Provider Name (Legal Business Name): SHAWNA MARIE PRINGLE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 WADSWORTH DRIVE
RICHMOND VA
23236-4510
US

IV. Provider business mailing address

771 PILOT HOUSE DRIVE SUITE A
NEWPORT NEWS VA
23606
US

V. Phone/Fax

Practice location:
  • Phone: 804-323-7874
  • Fax: 804-323-7879
Mailing address:
  • Phone: 757-873-2302
  • Fax: 757-873-2306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018301
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT018301
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305207042
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: