| Doctor Name: | MR. SHANE A. VATH |
| NPI Number: | 1912067760 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | SHANE VATH, DSC PT |
| License Number: | 2305005892 |
| Business Practice Address: | 100 Brewster Blvd Naval Hospital Camp Lejeune, NC - 285472538 |
| Business Phone Number: | 9104504159 |
| Business Fax Number: | 9104504194 |
| Mailing Address: | 100 Brewster Blvd, Naval Hospital CAMP LEJEUNE |
| State: | NC |
| Postal Code: | 285472538 |
| Phone Number: | 9104504159 |
| Fax Number: | 9104504194 |
| NPI Enumeration Date: | 12/11/2006 |
| NPI Last Update Date: | 08/10/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | 2305005892 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |