Provider Demographics
NPI:1508265521
Name:CARPER, SHANNON (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:CARPER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ROTARY DR
Mailing Address - Street 2:VALMONT INDUSTRIAL PARK
Mailing Address - City:WEST HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18202-1182
Mailing Address - Country:US
Mailing Address - Phone:570-459-6333
Mailing Address - Fax:
Practice Address - Street 1:106 ROTARY DR
Practice Address - Street 2:VALMONT INDUSTRIAL PARK
Practice Address - City:WEST HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-1182
Practice Address - Country:US
Practice Address - Phone:570-459-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023862225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist