Provider Demographics
NPI:1255082863
Name:BURKLAND, SHANNON MARIE
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:BURKLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 ELMWOOD LN
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-8956
Mailing Address - Country:US
Mailing Address - Phone:903-278-5757
Mailing Address - Fax:
Practice Address - Street 1:370 E REDCUT
Practice Address - Street 2:
Practice Address - City:FOUKE
Practice Address - State:AR
Practice Address - Zip Code:71837-8017
Practice Address - Country:US
Practice Address - Phone:870-653-4165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant