Provider Demographics
NPI:1831160621
Name:LOMINAC, SHANNON (PT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:LOMINAC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:CURTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 940
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-0940
Mailing Address - Country:US
Mailing Address - Phone:828-361-4120
Mailing Address - Fax:
Practice Address - Street 1:445 BILL BARKER RD
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-3740
Practice Address - Country:US
Practice Address - Phone:828-361-4120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6412225100000X
NC6341225100000X
GA7084225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3407029MedicaidHOME HEALTH
NC7210297MedicaidWESTCARE IPP#
NC7210532MedicaidMY IPP#
NC3400016MedicaidOUTPATIENT
TN3654136Medicaid
GA208822399AMedicaid
NC7210532MedicaidMY IPP#
GA65BBDGRMedicare ID - Type Unspecified