Provider Demographics
NPI:1750407748
Name:PENTONY, SHANNON (RPT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:PENTONY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8724 TRAVELING BREEZE AVE
Mailing Address - Street 2:UNIT 103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-7711
Mailing Address - Country:US
Mailing Address - Phone:702-990-2290
Mailing Address - Fax:702-932-8377
Practice Address - Street 1:880 SEVEN HILLS DR
Practice Address - Street 2:SUITE 140
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4371
Practice Address - Country:US
Practice Address - Phone:702-990-2290
Practice Address - Fax:702-937-8377
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV1799225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist