Provider Demographics
NPI:1376989095
Name:SKELTON, SHANNON EASTMAN (PT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:EASTMAN
Last Name:SKELTON
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 1:111 S LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2946
Mailing Address - Country:US
Mailing Address - Phone:662-418-3108
Mailing Address - Fax:
Practice Address - Street 1:111 S LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2946
Practice Address - Country:US
Practice Address - Phone:662-418-3108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist