Provider Demographics
NPI:1255060968
Name:POSSARDT, SHANNON NICOLE (DPT, NCS)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:NICOLE
Last Name:POSSARDT
Suffix:
Gender:F
Credentials:DPT, NCS
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:NICOLE
Other - Last Name:O'CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, NCS
Mailing Address - Street 1:654 W THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3027
Mailing Address - Country:US
Mailing Address - Phone:630-709-2331
Mailing Address - Fax:
Practice Address - Street 1:355 E ERIE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3167
Practice Address - Country:US
Practice Address - Phone:312-238-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.0272762251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology