Provider Demographics
NPI:1770737637
Name:SHANNON, JANET MUTH (PT)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:MUTH
Last Name:SHANNON
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 1:6238 PRESIDENTIAL CT
Mailing Address - Street 2:SUITE #1A
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3581
Mailing Address - Country:US
Mailing Address - Phone:239-337-1064
Mailing Address - Fax:239-337-1065
Practice Address - Street 1:6238 PRESIDENTIAL CT
Practice Address - Street 2:SUITE #1A
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3581
Practice Address - Country:US
Practice Address - Phone:239-337-1064
Practice Address - Fax:239-337-1065
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0008223225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist