Provider Demographics
NPI:1043326812
Name:LAYTON, SHANNON M (PT)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:M
Last Name:LAYTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:M
Other - Last Name:VOMUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:400 1ST CAPITOL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2880
Mailing Address - Country:US
Mailing Address - Phone:636-947-5467
Mailing Address - Fax:636-949-7084
Practice Address - Street 1:400 1ST CAPITOL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2880
Practice Address - Country:US
Practice Address - Phone:636-947-5467
Practice Address - Fax:636-949-7084
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000025510Medicare ID - Type UnspecifiedCMS PROV.#