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General NPI Number Information
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NPI Number | 1184847618
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Entity Type | Individual
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Provider Name | PAMELA GAIL SHIELDS PT
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 12779 TURBERVILLE LN
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City | HERNDON
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State | VA
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Zip | 20171
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Country | US
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Telephone | 571-308-8252
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Fax | 571-250-6305
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Provider Business Mailing Address
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Address Line | 12779 TURBERVILLE LN
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City | HERNDON
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State | VA
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Zip | 20171-2216
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Country | US
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Telephone | 937-672-1054
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT008971L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT871933
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 2305209578
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License Number State | VA
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