Provider Demographics
NPI:1417303249
Name:WOLVERTON, SHANNON D (DPT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:D
Last Name:WOLVERTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:DOWNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT
Mailing Address - Street 1:3532 VANN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3263
Mailing Address - Country:US
Mailing Address - Phone:205-508-3415
Mailing Address - Fax:205-508-3418
Practice Address - Street 1:3532 VANN RD STE 102
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3263
Practice Address - Country:US
Practice Address - Phone:205-508-3415
Practice Address - Fax:205-508-3418
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA301379174400000X
ALPTH8935225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist