Provider Demographics
NPI:1326648213
Name:CONERTY, SHANNON ELAINE BRADY (PT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ELAINE BRADY
Last Name:CONERTY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:ELAINE
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3405 OLD ANDERSON RD UNIT 305
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-1027
Mailing Address - Country:US
Mailing Address - Phone:615-424-2239
Mailing Address - Fax:
Practice Address - Street 1:115 STEWARTS FERRY PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-2917
Practice Address - Country:US
Practice Address - Phone:615-231-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist