Individual
SHANE VINCENT CASWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
10900 UNIVERSITY BOULEVARD, KATHERINE JOHNSON HALL, MSN 4E5, MANASSAS, VA 20110-2203
(703) 993-4638
(703) 993-2025
Mailing address
10900 UNIVERSITY BOULEVARD, KATHERINE JOHNSON HALL, MSN 4E5, MANASSAS, VA 20110-2203
(703) 993-4638
(703) 993-2025
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126000875
VA
Other
Enumeration date
05/16/2022
Last updated
05/25/2022
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