Healthcare Provider Details

I. General information

NPI: 1235801887
Provider Name (Legal Business Name): SHANNON WYANT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 TOWN CENTER DR STE B
WAYNESBORO VA
22980-9266
US

IV. Provider business mailing address

504 ALBEMARLE SQ
CHARLOTTESVILLE VA
22901-7405
US

V. Phone/Fax

Practice location:
  • Phone: 540-943-2222
  • Fax: 540-466-8061
Mailing address:
  • Phone: 434-817-7848
  • Fax: 434-465-6834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305214609
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: