Provider Demographics
NPI:1780993824
Name:HAYES, SHANNON (PT)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:HAYES
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 1:1525 WAMPANOAG TRAIL
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-1038
Mailing Address - Country:US
Mailing Address - Phone:401-433-4049
Mailing Address - Fax:401-433-0612
Practice Address - Street 1:400 MASSAOIT AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914
Practice Address - Country:US
Practice Address - Phone:401-270-8770
Practice Address - Fax:401-270-8772
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02328225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist