Provider Demographics
NPI:1538661772
Name:KLEINERT, SHANNON (DPT)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:KLEINERT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:SUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12085 TORREY RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-9702
Mailing Address - Country:US
Mailing Address - Phone:810-444-1342
Mailing Address - Fax:
Practice Address - Street 1:1447 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4727
Practice Address - Country:US
Practice Address - Phone:989-583-5113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-04
Last Update Date:2018-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015120225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist