Provider Demographics
NPI:1811770175
Name:TOWNE, SHANNON NICOLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:NICOLE
Last Name:TOWNE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:NICOLE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1823 HURLBURT ROAD
Mailing Address - Street 2:UNIT 4
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547
Mailing Address - Country:US
Mailing Address - Phone:850-244-0120
Mailing Address - Fax:850-244-0126
Practice Address - Street 1:1823 HURLBURT ROAD
Practice Address - Street 2:UNIT 4
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-244-0120
Practice Address - Fax:850-244-0126
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT39038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist