MEDICARE: SHAYNA B GROSS 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	225100000X	Physical Therapist	40QA01306200	NJ
2	225100000X	Physical Therapist	PT025756	PA
3	225100000X	Physical Therapist	PT007390	GA

General Provider Information

NPI Number	:	1952542573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAYNA B GROSS PT

Provider Business Mailing Address
First Line	:	360 SINCLAIR AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-1929
Country	:	US
Telephone Number	:	609-350-3864
Fax Number	:

Provider Business Practice Location Address
First Line	:	1189 EUCLID AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-1509
Country	:	US
Telephone Number	:	609-350-3864
Fax Number	:

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

Provider Enumeration Date	:	03/11/2009
Last Update Date	:	08/11/2025

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Directions to “ SHAYNA B GROSS PT” Practice Location

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