Provider Demographics
NPI:1225077472
Name:OSBRON, SHANNON M (PT)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:M
Last Name:OSBRON
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 1:1006 CORNERSTONE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5862
Mailing Address - Country:US
Mailing Address - Phone:731-407-4738
Mailing Address - Fax:731-407-4423
Practice Address - Street 1:1006 CORNERSTONE
Practice Address - Street 2:SUITE A
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242
Practice Address - Country:US
Practice Address - Phone:731-407-4738
Practice Address - Fax:731-407-4423
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT5032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4097590OtherBLUE CROSS BLUE SHIELD TN
TNP00613044OtherPALMETTO GBA RR MEDICARE
TN12115OtherVA
TN33297OtherTLC
TN3729568Medicaid
TN33297OtherTLC
TN4097590OtherBLUE CROSS BLUE SHIELD TN