Provider Demographics
NPI:1245318112
Name:DUNLAP, SHANNON C (PT)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:C
Last Name:DUNLAP
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 1:538 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-4126
Mailing Address - Country:US
Mailing Address - Phone:828-692-1176
Mailing Address - Fax:828-692-2109
Practice Address - Street 1:538 N OAK ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4126
Practice Address - Country:US
Practice Address - Phone:828-692-1176
Practice Address - Fax:828-692-2109
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211720Medicaid
NC2506753Medicare ID - Type UnspecifiedPHYSICAL THERAPY