Provider Demographics
NPI:1548410905
Name:DEANS, SHANNON DAVIS (PTA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:DAVIS
Last Name:DEANS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 WELLINGTON DR.
Mailing Address - Street 2:SUITE B
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893
Mailing Address - Country:US
Mailing Address - Phone:252-243-6818
Mailing Address - Fax:252-243-9557
Practice Address - Street 1:2303 WELLINGTON DR SW
Practice Address - Street 2:SUITE B
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-8620
Practice Address - Country:US
Practice Address - Phone:252-243-6818
Practice Address - Fax:252-243-9557
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3447225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant