Provider Demographics
NPI:1073162962
Name:MOLOUGHNEY, SHANNON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MOLOUGHNEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BELMAR
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-2014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:455 ROUTE 9
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8274
Practice Address - Country:US
Practice Address - Phone:732-617-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01876900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist