Provider Demographics
NPI:1760947758
Name:LEGHART, SHANNON RAE (MAT, LAT, ATC ,BSAS)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:RAE
Last Name:LEGHART
Suffix:
Gender:F
Credentials:MAT, LAT, ATC ,BSAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6361 HELEN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15129-9653
Mailing Address - Country:US
Mailing Address - Phone:412-251-1070
Mailing Address - Fax:
Practice Address - Street 1:46400 LEXINGTON VILLAGE WAY STE 108
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-5570
Practice Address - Country:US
Practice Address - Phone:301-798-7020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program