Provider Demographics
NPI:1689978181
Name:LLOYD, SHANNON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:LLOYD
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 1:123 TALBOT RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-4015
Mailing Address - Country:US
Mailing Address - Phone:912-484-0940
Mailing Address - Fax:
Practice Address - Street 1:123 TALBOT RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-4015
Practice Address - Country:US
Practice Address - Phone:912-484-0940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9096225100000X
KY005821225100000X
GAPT013247225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003199814DMedicaid