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Individual

SHAWN VAN DECKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PTA, OPTA, CPT

Contact information

Practice address
611 WATKINS CENTRE PKWY, MIDLOTHIAN, VA 23114-4404
(804) 325-8822
Mailing address
611 WATKINS CENTRE PKWY, MIDLOTHIAN, VA 23114-4404
(804) 325-8822

Taxonomy

Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
2306603530
VA

Other

Enumeration date
01/13/2020
Last updated
01/13/2020
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