MEDICARE: GREGORY B SHASBY PHD, PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	004092	KY
2	225100000X	Physical Therapist	2305205897	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00217523	OTHER	KY	TRAVELERS MEDICARE ID
3	P00930518	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	342327	OTHER	VA	BCBS (PHYSICAL THERAPY)
4	7263602	OTHER		AETNA PROVIDER ID
5	000000331732	OTHER	KY	ANTHEM BCBS PROVIDER ID
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003906793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY B SHASBY PHD, PT

Provider Business Mailing Address
First Line	:	771 PILOT HOUSE DR
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-1990
Country	:	US
Telephone Number	:	757-873-2302
Fax Number	:	757-873-2306

Provider Business Practice Location Address
First Line	:	10128 W BROAD ST
Second Line	:	FORUM BLDG III, SUITE K
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-6761
Country	:	US
Telephone Number	:	804-217-9210
Fax Number	:	804-217-9213

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/19/2011

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