Provider Demographics
NPI:1962573717
Name:ALLEN, SHANNON H (PT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:H
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1267 ENTERPRISE WAY NW STE 150
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-4472
Mailing Address - Country:US
Mailing Address - Phone:256-713-1872
Mailing Address - Fax:256-713-1873
Practice Address - Street 1:165 WHITESPORT DR SW STE 2
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-7427
Practice Address - Country:US
Practice Address - Phone:256-713-1872
Practice Address - Fax:256-713-1873
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051546004OtherBCBS
AL051546005OtherBCBS
AL051546005OtherBCBS