Provider Demographics
NPI:1962673913
Name:SHANNON, ANNE GENEVIEVE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:GENEVIEVE
Last Name:SHANNON
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
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Mailing Address - Street 1:1 ANGEST CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4201
Mailing Address - Country:US
Mailing Address - Phone:314-495-8718
Mailing Address - Fax:314-962-7701
Practice Address - Street 1:1000 DES PERES RD
Practice Address - Street 2:120
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2050
Practice Address - Country:US
Practice Address - Phone:314-495-8718
Practice Address - Fax:314-962-7701
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2006028602225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist