Provider Demographics
NPI:1952602203
Name:GREENLAW, SHANNON R (DPT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:R
Last Name:GREENLAW
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 N MCDONALD RD
Mailing Address - Street 2:SUITE L2
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1557
Mailing Address - Country:US
Mailing Address - Phone:509-893-4462
Mailing Address - Fax:509-893-4482
Practice Address - Street 1:1215 N MCDONALD RD
Practice Address - Street 2:SUITE L2
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1557
Practice Address - Country:US
Practice Address - Phone:509-893-4462
Practice Address - Fax:509-893-4482
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
WAPT60222356225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT317136OtherPT LICENSE