Provider Demographics
NPI:1821621418
Name:MAREK, SHANNON ALEXIS (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ALEXIS
Last Name:MAREK
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 BUTTERFLY DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-7918
Mailing Address - Country:US
Mailing Address - Phone:254-913-2521
Mailing Address - Fax:
Practice Address - Street 1:624 TIGER DR
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513
Practice Address - Country:US
Practice Address - Phone:254-215-2243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT60042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer