Provider Demographics
NPI:1891336236
Name:RITCHEY, SHANNON (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:RITCHEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:O'NEILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2211 HILLSBOROUGH RD APT 2036
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4174
Mailing Address - Country:US
Mailing Address - Phone:316-993-0792
Mailing Address - Fax:
Practice Address - Street 1:3326 DURHAM CHAPEL HILL BLVD STE 230
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6239
Practice Address - Country:US
Practice Address - Phone:316-993-0792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19181225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist