Individual
MRS. SHARDONNAY REAVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3310 FALL HILL AVE, FREDERICKSBURG, VA 22401-3000
(540) 373-7133
(540) 373-0068
Mailing address
9339 MOUNTAIN RUN LAKE RD, CULPEPER, VA 22701-7354
(540) 229-0251
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306604307
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C09813
MEDICARE IDENTIFICATION NUMBER
VA
Enumeration date
11/03/2015
Last updated
11/03/2015
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