Provider Demographics
NPI:1528226909
Name:FRANKLIN, SHANNA (MPT)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:FRANKLIN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5231 W VILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-4368
Mailing Address - Country:US
Mailing Address - Phone:414-463-1670
Mailing Address - Fax:414-463-1742
Practice Address - Street 1:5231 W VILLARD AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-4368
Practice Address - Country:US
Practice Address - Phone:414-463-1670
Practice Address - Fax:414-463-1742
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI09641-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36134000Medicaid