Provider Demographics
NPI:1558976381
Name:KNECHT, SHANNON L (DPT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:KNECHT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 113
Mailing Address - Street 2:
Mailing Address - City:COLEBROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03576-0113
Mailing Address - Country:US
Mailing Address - Phone:603-915-7003
Mailing Address - Fax:
Practice Address - Street 1:181 CORLISS LN
Practice Address - Street 2:
Practice Address - City:COLEBROOK
Practice Address - State:NH
Practice Address - Zip Code:03576-3207
Practice Address - Country:US
Practice Address - Phone:603-388-4206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0134208225100000X
NH4421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist