Provider Demographics
NPI:1720118383
Name:CULLAGH, SHANNON (PT)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:
Last Name:CULLAGH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:MARY
Other - Last Name:GILHOOLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:825 WASHINGTON ST
Mailing Address - Street 2:STE 280 PHYSICAL THERAPY AND SPORTS REHAB INC
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062
Mailing Address - Country:US
Mailing Address - Phone:781-769-2040
Mailing Address - Fax:781-769-1914
Practice Address - Street 1:227 DEDHAM ST
Practice Address - Street 2:PHYSICAL THERAPY AND SPORTS REHAB INC
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056
Practice Address - Country:US
Practice Address - Phone:508-384-7020
Practice Address - Fax:508-384-7025
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist