Provider Demographics
NPI:1609024843
Name:SHANNON, NATALIE ALEXA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ALEXA
Last Name:SHANNON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1483 GADSDEN HWY
Mailing Address - Street 2:SUITE 112
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3160
Mailing Address - Country:US
Mailing Address - Phone:205-655-9222
Mailing Address - Fax:205-655-9233
Practice Address - Street 1:5057 PINNACLE SQUARE
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35235-0001
Practice Address - Country:US
Practice Address - Phone:205-655-9222
Practice Address - Fax:205-655-9233
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005774225100000X
AL10092255A2300X
ALPTH6158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer