Provider Demographics
NPI:1184050007
Name:REESE, SHANNON KATHLEEN (PTA)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:KATHLEEN
Last Name:REESE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 CEDAR BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37074-3926
Mailing Address - Country:US
Mailing Address - Phone:615-374-3744
Mailing Address - Fax:
Practice Address - Street 1:5000 CROSSING CIRCLE
Practice Address - Street 2:STE 100
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122
Practice Address - Country:US
Practice Address - Phone:615-758-2490
Practice Address - Fax:615-758-2492
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000004685225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant