Provider Demographics
NPI:1255159315
Name:BOOTH, SHANNON ELIZABETH (PT, DPT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ELIZABETH
Last Name:BOOTH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 BRANDT DR APT 5303
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6479
Mailing Address - Country:US
Mailing Address - Phone:814-619-9339
Mailing Address - Fax:
Practice Address - Street 1:1005 BEAVER GRADE RD STE 120
Practice Address - Street 2:
Practice Address - City:MOON TWP
Practice Address - State:PA
Practice Address - Zip Code:15108-2964
Practice Address - Country:US
Practice Address - Phone:412-724-0964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT032744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist