Provider Demographics
NPI:1912068172
Name:BROOKS, SHANNON (MASTER PT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MASTER PT
Other - Prefix:
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Mailing Address - Street 1:1038 N EISENHOWER DR
Mailing Address - Street 2:PMB 291
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3116
Mailing Address - Country:US
Mailing Address - Phone:304-253-1130
Mailing Address - Fax:304-253-1150
Practice Address - Street 1:217 BROOKSHIRE LN
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6729
Practice Address - Country:US
Practice Address - Phone:304-253-1130
Practice Address - Fax:304-253-1150
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2015-05-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV002068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist