Provider Demographics
NPI:1508028184
Name:BELCHER, SHANNON RAE (LPTA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:RAE
Last Name:BELCHER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 MEADOW FRK
Mailing Address - Street 2:
Mailing Address - City:MILLSTONE
Mailing Address - State:KY
Mailing Address - Zip Code:41838-9067
Mailing Address - Country:US
Mailing Address - Phone:606-855-4883
Mailing Address - Fax:
Practice Address - Street 1:134 MEADOW FRK
Practice Address - Street 2:
Practice Address - City:MILLSTONE
Practice Address - State:KY
Practice Address - Zip Code:41838-9067
Practice Address - Country:US
Practice Address - Phone:606-855-4883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA01693225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant