Provider Demographics
NPI:1952990764
Name:DONOHOE, SHANNON LEE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEE
Last Name:DONOHOE
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 1:920 LANDER DR UNIT 210
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8184
Mailing Address - Country:US
Mailing Address - Phone:315-532-5803
Mailing Address - Fax:
Practice Address - Street 1:4720 GREY MOSS DR
Practice Address - Street 2:
Practice Address - City:CLOVER
Practice Address - State:SC
Practice Address - Zip Code:29710-8706
Practice Address - Country:US
Practice Address - Phone:803-240-5502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist