Provider Demographics
NPI:1104330638
Name:GARCIA, SHANNON CARRIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:CARRIE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:CARRIET
Other - Last Name:MENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:23632 ATEX CT
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-4521
Mailing Address - Country:US
Mailing Address - Phone:760-484-6309
Mailing Address - Fax:
Practice Address - Street 1:215 S HICKORY ST STE 112
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4360
Practice Address - Country:US
Practice Address - Phone:760-737-8460
Practice Address - Fax:760-739-5669
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist