Provider Demographics
NPI:1184857096
Name:CLEVELAND, SHANNON LYNNE (DPT)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:LYNNE
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:230 CHATEAU DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4751
Mailing Address - Country:US
Mailing Address - Phone:404-513-6635
Mailing Address - Fax:678-248-9006
Practice Address - Street 1:414 LONG SHORE WAY
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-6115
Practice Address - Country:US
Practice Address - Phone:404-513-6635
Practice Address - Fax:678-248-9006
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT#0074802251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic