Provider Demographics
NPI:1679936967
Name:HARMS, SHANNON KATHLEEN (LAT, ATC, CES)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:KATHLEEN
Last Name:HARMS
Suffix:
Gender:F
Credentials:LAT, ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5527 WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-2637
Mailing Address - Country:US
Mailing Address - Phone:314-520-0330
Mailing Address - Fax:
Practice Address - Street 1:6100 MAIN ST # MS 548
Practice Address - Street 2:TUDOR FIELDHOUSE / ATHLETIC TRAINING
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1827
Practice Address - Country:US
Practice Address - Phone:512-540-1649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT63362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer