Provider Demographics
NPI:1558777383
Name:LEFTWICH, SHANNON (ATC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:LEFTWICH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 HARNEY ST
Mailing Address - Street 2:STE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-2250
Mailing Address - Country:US
Mailing Address - Phone:402-559-0091
Mailing Address - Fax:
Practice Address - Street 1:1415 HARNEY ST
Practice Address - Street 2:STE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-2250
Practice Address - Country:US
Practice Address - Phone:402-559-0091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer