Provider Demographics
NPI:1588610620
Name:LEGGETT, SHANNON (PT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:LEGGETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 LEXINGTON AVE
Mailing Address - Street 2:C/O 92ND STREET Y, MEZZANINE LEVEL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1612
Mailing Address - Country:US
Mailing Address - Phone:646-707-0400
Mailing Address - Fax:646-707-0380
Practice Address - Street 1:1395 LEXINGTON AVE
Practice Address - Street 2:C/O 92ND STREET Y, MEZZANINE LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1612
Practice Address - Country:US
Practice Address - Phone:646-707-0400
Practice Address - Fax:646-707-0380
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist