Provider Demographics
NPI:1942285226
Name:SCHRAM, SHANNON MECHELE (DPT)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:MECHELE
Last Name:SCHRAM
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 1:900 NE 139TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-2513
Mailing Address - Country:US
Mailing Address - Phone:360-573-3611
Mailing Address - Fax:360-573-3880
Practice Address - Street 1:900 NE 139TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2513
Practice Address - Country:US
Practice Address - Phone:360-573-3611
Practice Address - Fax:360-573-3880
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8855009Medicare ID - Type Unspecified