Provider Demographics
NPI:1013723279
Name:TORTOLANO, SHANNON (LMT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:TORTOLANO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 BASIN RD
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:VT
Mailing Address - Zip Code:05354-9407
Mailing Address - Country:US
Mailing Address - Phone:541-806-3887
Mailing Address - Fax:
Practice Address - Street 1:8 UNIVERSITY WAY
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-4423
Practice Address - Country:US
Practice Address - Phone:802-451-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT164.0001595225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist