Provider Demographics
NPI:1194768036
Name:HILL, SHANNON ELIZABETH (PT MPT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ELIZABETH
Last Name:HILL
Suffix:
Gender:F
Credentials:PT MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26800 ALISO VIEJO PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2607
Mailing Address - Country:US
Mailing Address - Phone:949-716-4548
Mailing Address - Fax:949-271-2311
Practice Address - Street 1:26800 ALISO VIEJO PKWY STE 130
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-2607
Practice Address - Country:US
Practice Address - Phone:949-716-4548
Practice Address - Fax:949-271-2311
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 234912251G0304X
CA23491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q42234Medicare UPIN
WPT23491DMedicare PIN