Provider Demographics
NPI:1437369535
Name:BECK, SHANNAN LYN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:SHANNAN
Middle Name:LYN
Last Name:BECK
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:SHANNAN
Other - Middle Name:LYN
Other - Last Name:GRUBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:13701 MCGUIRE ST
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4469
Mailing Address - Country:US
Mailing Address - Phone:734-947-9535
Mailing Address - Fax:
Practice Address - Street 1:10000 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3330
Practice Address - Country:US
Practice Address - Phone:313-375-7109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist