Provider Demographics
NPI:1619173887
Name:COLLINS, SHANNON LEE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LEE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MT. HOLLY RD.
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05738
Mailing Address - Country:US
Mailing Address - Phone:802-492-2235
Mailing Address - Fax:802-886-2174
Practice Address - Street 1:25 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-3050
Practice Address - Country:US
Practice Address - Phone:802-886-2172
Practice Address - Fax:802-886-2174
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist