Individual
GREGORY B SHASBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD, PT
Contact information
Practice address
10128 W BROAD ST, FORUM BLDG III, SUITE K, GLEN ALLEN, VA 23060-6761
(804) 217-9210
(804) 217-9213
Mailing address
771 PILOT HOUSE DR, NEWPORT NEWS, VA 23606-1990
(757) 873-2302
(757) 873-2306
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
004092
KY
225100000X
Physical Therapist
Primary
2305205897
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000331732
ANTHEM BCBS PROVIDER ID
KY
05
—
1003906793
—
VA
01
—
342327
BCBS (PHYSICAL THERAPY)
VA
01
—
7263602
AETNA PROVIDER ID
—
01
—
P00217523
TRAVELERS MEDICARE ID
KY
01
—
P00930518
RAILROAD MEDICARE
VA
Enumeration date
10/13/2006
Last updated
07/19/2011
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