Provider Demographics
NPI:1306137534
Name:PARKER, SHANNON L (MPT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:PARKER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14021 BELLAGIO WAY UNIT 309
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-2705
Mailing Address - Country:US
Mailing Address - Phone:256-230-5382
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:14021 BELLAGIO WAY UNIT 309
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-2705
Practice Address - Country:US
Practice Address - Phone:256-230-5382
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12913225100000X
FL34082225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist