Provider Demographics
NPI:1013956184
Name:ZOOK, SHANNON D (MPT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:D
Last Name:ZOOK
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 REGENTS BLVD
Mailing Address - Street 2:
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6030
Mailing Address - Country:US
Mailing Address - Phone:253-202-6858
Mailing Address - Fax:
Practice Address - Street 1:1027 REGENTS BLVD
Practice Address - Street 2:
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6030
Practice Address - Country:US
Practice Address - Phone:253-202-6858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008775225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8346868Medicaid
WA8930589OtherL&I CRIME VICTIMS PROGRAM
WA1440ZOOtherREGENCE BLUESHIELD
WA154859OtherLABOR & INDUSTRIES
WAAB33414Medicare ID - Type Unspecified
WA154859OtherLABOR & INDUSTRIES