Provider Demographics
NPI:1972688281
Name:MCGANNON, BRITT SHORE (LPT)
Entity Type:Individual
Prefix:
First Name:BRITT
Middle Name:SHORE
Last Name:MCGANNON
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:BRITT
Other - Middle Name:SHORE
Other - Last Name:HASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT
Mailing Address - Street 1:P.O. BOX 2500
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-9000
Mailing Address - Country:US
Mailing Address - Phone:972-771-0999
Mailing Address - Fax:972-771-2281
Practice Address - Street 1:5501 GORDON SMITH ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-3210
Practice Address - Country:US
Practice Address - Phone:972-475-5122
Practice Address - Fax:972-475-1299
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1137446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165348701Medicaid
456643Medicare Oscar/Certification
456643Medicare PIN