Provider Demographics
NPI:1316088560
Name:PATTERSON, SHANNON K (LPT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:K
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:K
Other - Last Name:LAIRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT
Mailing Address - Street 1:940 N TYLER RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3265
Mailing Address - Country:US
Mailing Address - Phone:316-773-0909
Mailing Address - Fax:316-773-0606
Practice Address - Street 1:940 N TYLER RD
Practice Address - Street 2:STE. 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3265
Practice Address - Country:US
Practice Address - Phone:316-773-0909
Practice Address - Fax:316-773-0606
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS140625Medicare ID - Type UnspecifiedOLD #, NEW ONE PENDING