Provider Demographics
NPI:1831817436
Name:MORRISEY, SHANNON (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:MORRISEY
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 1:10 MINUTEMAN DR
Mailing Address - Street 2:
Mailing Address - City:TYNGSBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01879-2387
Mailing Address - Country:US
Mailing Address - Phone:978-846-5568
Mailing Address - Fax:
Practice Address - Street 1:4700 HALE PKWY STE 550
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4053
Practice Address - Country:US
Practice Address - Phone:303-321-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
VA2305216911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305216911OtherVIRGINIA BOARD OF PHYSICAL THERAPY