Provider Demographics
NPI:1306329131
Name:THARP, SHANNON R
Entity type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:R
Last Name:THARP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8309 FLYTHE MILL RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-2021
Mailing Address - Country:US
Mailing Address - Phone:414-610-8655
Mailing Address - Fax:
Practice Address - Street 1:8309 FLYTHE MILL RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-2021
Practice Address - Country:US
Practice Address - Phone:414-610-8655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health