Provider Demographics
NPI:1114293438
Name:RIPLEY, SHANNON (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:RIPLEY
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:SHANON
Other - Middle Name:
Other - Last Name:REYNOLDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4611 192ND ST SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5508
Mailing Address - Country:US
Mailing Address - Phone:509-342-1006
Mailing Address - Fax:
Practice Address - Street 1:4611 192ND ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5508
Practice Address - Country:US
Practice Address - Phone:509-342-1006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer