Provider Demographics
NPI:1023237203
Name:HARTLEY, SHANNON (PT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 L V STABLER DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037-3850
Mailing Address - Country:US
Mailing Address - Phone:334-383-2256
Mailing Address - Fax:334-383-2341
Practice Address - Street 1:29 L V STABLER DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-3850
Practice Address - Country:US
Practice Address - Phone:334-383-2256
Practice Address - Fax:334-383-2341
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51502576OtherBCBS AL PROVIDOR #