Provider Demographics
NPI:1821719311
Name:SHINGLETON, CARISSA BREANNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:BREANNE
Last Name:SHINGLETON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:BREANNE
Other - Last Name:OOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1542 CREEKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-5062
Mailing Address - Country:US
Mailing Address - Phone:317-340-7203
Mailing Address - Fax:
Practice Address - Street 1:1542 CREEKSIDE LN
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-5062
Practice Address - Country:US
Practice Address - Phone:317-340-7203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05014655A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist