MEDICARE: NICOLE E SHENK 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	23670	MD
2	225100000X	Physical Therapist	2305207352	VA
3	225100000X	Physical Therapist	871780	DC

General Provider Information

NPI Number	:	1972899763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE E SHENK PT

Provider Business Mailing Address
First Line	:	4040 FAIRFAX DR STE 120
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22203-1613
Country	:	US
Telephone Number	:	703-292-4060
Fax Number	:	703-292-4066

Provider Business Practice Location Address
First Line	:	4040 FAIRFAX DR STE 120
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22203-1613
Country	:	US
Telephone Number	:	703-292-4060
Fax Number	:	703-292-4066

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

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	01/03/2024

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Directions to “ NICOLE E SHENK PT” Practice Location

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