Provider Demographics
NPI:1851639298
Name:MCPHERSON, SHANNON KELLIE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:KELLIE
Last Name:MCPHERSON
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 1:388 CAPE RD
Mailing Address - Street 2:
Mailing Address - City:HOLLIS CENTER
Mailing Address - State:ME
Mailing Address - Zip Code:04042-3712
Mailing Address - Country:US
Mailing Address - Phone:207-298-2651
Mailing Address - Fax:
Practice Address - Street 1:561 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3308
Practice Address - Country:US
Practice Address - Phone:207-536-4968
Practice Address - Fax:207-213-4116
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3976225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist