Basic Information
| Provider Information | |||||||||
| NPI: | 1003906793 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHASBY | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | PHD, PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 771 PILOT HOUSE DR | ||||||||
| Address2: | |||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236061990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578732302 | ||||||||
| FaxNumber: | 7578732306 | ||||||||
| Practice Location | |||||||||
| Address1: | 10128 W BROAD ST | ||||||||
| Address2: | FORUM BLDG III, SUITE K | ||||||||
| City: | GLEN ALLEN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230606761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042179210 | ||||||||
| FaxNumber: | 8042179213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 07/19/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 004092 | KY | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 225100000X | 2305205897 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 342327 | 01 | VA | BCBS (PHYSICAL THERAPY) | OTHER | P00217523 | 01 | KY | TRAVELERS MEDICARE ID | OTHER | P00930518 | 01 | VA | RAILROAD MEDICARE | OTHER | 7263602 | 01 | AETNA PROVIDER ID | OTHER | 000000331732 | 01 | KY | ANTHEM BCBS PROVIDER ID | OTHER | 1003906793 | 05 | VA | MEDICAID |