Shardonnay Reaves, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2306604307 Issued in VA

Practice address

3310 Fall Hill Ave
Fredericksburg, VA 22401-3000

Phone

(540) 373-7133

Fax

(540) 373-0068

NPI assigned

Nov 3, 2015

Last updated

Nov 3, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1446508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446508800000",
    "number": "1174996888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9339 MOUNTAIN RUN LAKE RD",
            "city": "CULPEPER",
            "state": "VA",
            "postal_code": "227017354",
            "telephone_number": "540-229-0251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3310 FALL HILL AVE",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224013000",
            "telephone_number": "540-373-7133",
            "fax_number": "540-373-0068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REAVES",
        "first_name": "SHARDONNAY",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-11-03",
        "last_updated": "2015-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "VA",
            "license": "2306604307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE IDENTIFICATION NUMBER",
            "identifier": "C09813",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Syed Wajahat Raza
• Grace K Razavian
• Reaching Potentials VA, LLC
• Reaching Potentials, Inc.
• Katelyn Reanos, DNP
• Elizabeth Reckard, LMT
• Sol L Redd-Martin, MSW, LCSW
• Nikhila Reddy, PA-C
• Ramakota K Reddy, M.D.
• Kellene Redington

• Physical Therapy Assistant in Fredericksburg, VA
• Providers in Fredericksburg, VA by specialty
• Physical Therapy Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.