Provider Demographics
NPI:1285757484
Name:BARKER, SHANNON ARTHUR (DPT)
Entity type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:ARTHUR
Last Name:BARKER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MERMAN RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-3446
Mailing Address - Country:US
Mailing Address - Phone:423-224-5751
Mailing Address - Fax:423-224-5776
Practice Address - Street 1:103 W STONE DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3220
Practice Address - Country:US
Practice Address - Phone:423-224-5751
Practice Address - Fax:423-224-5776
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7175225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I652915Medicare PIN
TN103I655695Medicare PIN