Provider Demographics
NPI:1356437438
Name:RATERMANN, SHANNON ALLISON (PT)
Entity type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:ALLISON
Last Name:RATERMANN
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:PO BOX 450517
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74345-0517
Mailing Address - Country:US
Mailing Address - Phone:918-353-2309
Mailing Address - Fax:918-787-7889
Practice Address - Street 1:1200 S SHUNDI
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-1014
Practice Address - Country:US
Practice Address - Phone:918-353-2309
Practice Address - Fax:918-787-7889
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3886225100000X
KS3705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist