Provider Demographics
NPI:1598016461
Name:NORTH, SHIRLEA (PT, DPT)
Entity type:Individual
Prefix:
First Name:SHIRLEA
Middle Name:
Last Name:NORTH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5003 WESTFIELDS BLVD
Mailing Address - Street 2:PO BOX 230022
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120
Mailing Address - Country:US
Mailing Address - Phone:703-594-6314
Mailing Address - Fax:
Practice Address - Street 1:5130 WOODFIELD DR
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-4119
Practice Address - Country:US
Practice Address - Phone:703-594-6314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist