Provider Demographics
NPI:1205906724
Name:NEWPORT, SHANNON KAY (PTA)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:KAY
Last Name:NEWPORT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:146 WHITE LOOP RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716
Mailing Address - Country:US
Mailing Address - Phone:865-414-8724
Mailing Address - Fax:
Practice Address - Street 1:809 E EMERALD AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917
Practice Address - Country:US
Practice Address - Phone:865-524-7366
Practice Address - Fax:865-637-4402
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant