Provider Demographics
NPI:1194106344
Name:LANSKIS, SHANNON A (DPT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:A
Last Name:LANSKIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:A
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:435 ASH STREET
Mailing Address - Street 2:101
Mailing Address - City:NEW WESTMINSTER
Mailing Address - State:BRITISH COLUMBIA
Mailing Address - Zip Code:V3M3N2
Mailing Address - Country:CA
Mailing Address - Phone:604-379-0940
Mailing Address - Fax:
Practice Address - Street 1:855 AARON DR
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-9396
Practice Address - Country:US
Practice Address - Phone:360-354-4434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-13
Last Update Date:2015-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60559800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist