Provider Demographics
NPI:1780101550
Name:MURPHY, SHANNON RITA (PT, DPT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:RITA
Last Name:MURPHY
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 1:2140 N LINCOLN AVE APT 5107
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4542
Mailing Address - Country:US
Mailing Address - Phone:904-327-0754
Mailing Address - Fax:
Practice Address - Street 1:3232 LAKE AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1073
Practice Address - Country:US
Practice Address - Phone:224-266-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2022-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.023143225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist