Provider Demographics
NPI:1922266980
Name:CAWLEY, SHANNON LEE (PT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEE
Last Name:CAWLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MORGAN HWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-2641
Mailing Address - Country:US
Mailing Address - Phone:570-344-3788
Mailing Address - Fax:570-969-9280
Practice Address - Street 1:5 MORGAN HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-2641
Practice Address - Country:US
Practice Address - Phone:570-344-3788
Practice Address - Fax:570-969-9280
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009804L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA9521151OtherAETNA PPO
PA002129848OtherBLUE SHIELD
PA5213859OtherAETNA HMO
PA834084OtherFPH
PA834084OtherFPH
PA002129848OtherBLUE SHIELD