Provider Demographics
NPI:1841664430
Name:NARASIMHAN, SHANNON NOEL (DPT)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:NOEL
Last Name:NARASIMHAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:68 E WADS PARK DR #230
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020
Mailing Address - Country:US
Mailing Address - Phone:630-296-2222
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:68 E WADS PARK DR #230
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020
Practice Address - Country:US
Practice Address - Phone:206-386-5600
Practice Address - Fax:206-386-5600
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60632852225100000X
NY62035169225100000X
IL070.026315225100000X
IDPT-7915225100000X
HIPT-5348225100000X
WAPT60632852225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist