Provider Demographics
NPI:1659888303
Name:MCCORD, SHANNON KATE (DPT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:KATE
Last Name:MCCORD
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 1:3411 E COMPTON RD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-6879
Mailing Address - Country:US
Mailing Address - Phone:862-432-6733
Mailing Address - Fax:
Practice Address - Street 1:1001 MCCUTCHEON CREEK LN
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-1050
Practice Address - Country:US
Practice Address - Phone:931-451-1899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8878225100000X
TN12485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist