Provider Demographics
NPI:1972218402
Name:KOHNLE, SHANNON MCMANUS (LMBT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MCMANUS
Last Name:KOHNLE
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 BARBEE FARM DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-5606
Mailing Address - Country:US
Mailing Address - Phone:704-517-2279
Mailing Address - Fax:
Practice Address - Street 1:933 BARBEE FARM DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-5606
Practice Address - Country:US
Practice Address - Phone:704-517-2279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11589225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist