Provider Demographics
NPI:1801197165
Name:HITCHCOCK, SHANNON LEIGH (DPT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEIGH
Last Name:HITCHCOCK
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 1:2976 N SCATTERFIELD RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-1585
Mailing Address - Country:US
Mailing Address - Phone:765-643-8781
Mailing Address - Fax:765-641-2385
Practice Address - Street 1:2976 N SCATTERFIELD RD
Practice Address - Street 2:SUITE F
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-1585
Practice Address - Country:US
Practice Address - Phone:765-643-8781
Practice Address - Fax:765-641-2385
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009411A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist