Provider Demographics
NPI:1972541209
Name:SCOGGINS, SHANNON R (PT)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:R
Last Name:SCOGGINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:RENEE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:520 COOK STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:MADISONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37354
Mailing Address - Country:US
Mailing Address - Phone:423-442-1440
Mailing Address - Fax:423-442-1441
Practice Address - Street 1:520 COOK STREET
Practice Address - Street 2:SUITE D
Practice Address - City:MADISONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37354
Practice Address - Country:US
Practice Address - Phone:423-442-1440
Practice Address - Fax:423-442-1441
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3156797OtherBCBST - GROUP NUMBER
TN0446652Medicaid
TN0446652Medicaid