Provider Demographics
NPI:1023352242
Name:SHAPOURI, SABA (PT, DPT)
Entity type:Individual
Prefix:
First Name:SABA
Middle Name:
Last Name:SHAPOURI
Suffix:
Gender:M
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 1:6856 PIEDMONT CENTER PLZ
Mailing Address - Street 2:#C-4
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-4034
Mailing Address - Country:US
Mailing Address - Phone:703-754-6955
Mailing Address - Fax:703-754-6956
Practice Address - Street 1:6856 PIEDMONT CENTER PLZ
Practice Address - Street 2:#C-4
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-4034
Practice Address - Country:US
Practice Address - Phone:703-754-6955
Practice Address - Fax:703-754-6956
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207718225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist