Provider Demographics
NPI:1811556228
Name:MORRISON, SHAWNA LEIGH (PTA)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:LEIGH
Last Name:MORRISON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20739 N 1050TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST YORK
Mailing Address - State:IL
Mailing Address - Zip Code:62478-2020
Mailing Address - Country:US
Mailing Address - Phone:618-562-0812
Mailing Address - Fax:
Practice Address - Street 1:20739 N 1050TH ST
Practice Address - Street 2:
Practice Address - City:WEST YORK
Practice Address - State:IL
Practice Address - Zip Code:62478-2020
Practice Address - Country:US
Practice Address - Phone:618-562-0812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160007693225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant