Healthcare Provider Details

I. General information

NPI: 1952388993
Provider Name (Legal Business Name): SHANA D GARLAND PT ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 LITTLE NECK RD BLDG 3000 DYNAMIC HEALTH SERVICES
VIRGINIA BEACH VA
23452
US

IV. Provider business mailing address

524 DIAMOND PLUM CIRCLE APT 302
VIRGINIA BEACH VA
23452
US

V. Phone/Fax

Practice location:
  • Phone: 757-639-3153
  • Fax:
Mailing address:
  • Phone: 757-274-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305203825
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126000855
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: