Provider Demographics
NPI:1083707830
Name:PEEL, SHANNON PATRICK (ATC)
Entity Type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:PATRICK
Last Name:PEEL
Suffix:
Gender:M
Credentials:ATC
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:JACOBSON ATHLETIC BUILDING
Mailing Address - Street 2:1800 SOUTH 4TH STREET
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50011-0001
Mailing Address - Country:US
Mailing Address - Phone:515-294-7029
Mailing Address - Fax:515-294-6554
Practice Address - Street 1:JACOBSON ATHLETIC BUILDING
Practice Address - Street 2:1800 SOUTH 4TH STREET
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50011-0001
Practice Address - Country:US
Practice Address - Phone:515-294-7029
Practice Address - Fax:515-294-6554
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer