Provider Demographics
NPI:1083497994
Name:HOUSTON, SHAWNA (PT)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:HOUSTON
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 1:622 W POPLAR AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2578
Mailing Address - Country:US
Mailing Address - Phone:901-850-5246
Mailing Address - Fax:901-850-5226
Practice Address - Street 1:622 W POPLAR AVE STE 5
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2578
Practice Address - Country:US
Practice Address - Phone:901-850-5246
Practice Address - Fax:901-850-5226
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14992225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist