Provider Demographics
NPI:1023188430
Name:SHANNON, CHRISTOPHER (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:SHANNON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5718
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-5718
Mailing Address - Country:US
Mailing Address - Phone:855-456-7146
Mailing Address - Fax:406-309-2579
Practice Address - Street 1:13215 SE 240TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-5120
Practice Address - Country:US
Practice Address - Phone:253-631-3026
Practice Address - Fax:253-631-3899
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008717225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB27792Medicare PIN
WA8939972OtherCRIME VICTIMS
WA8319410Medicaid
WA0291579OtherDEPT. OF LABOR AND INDUSTRIES
WA194292OtherDEPT OF LABOR & INDUSTRY
WA3452SHOtherREGENCE BLUE SHIELD
WAAB27793Medicare ID - Type UnspecifiedPIERCE COUNTY
WAAB27792Medicare ID - Type UnspecifiedKING COUNTY