Healthcare Provider Details

I. General information

NPI: 1013201680
Provider Name (Legal Business Name): SHEREETA MCLANE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 262
SANDSTON VA
23150-0262
US

IV. Provider business mailing address

PO BOX 262
SANDSTON VA
23150-0262
US

V. Phone/Fax

Practice location:
  • Phone: 804-000-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305204242
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: