MEDICARE: SHANNON D ZOOK MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT00008775	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8930589	OTHER	WA	L&I CRIME VICTIMS PROGRAM
3	1440ZO	OTHER	WA	REGENCE BLUESHIELD
4	154859	OTHER	WA	LABOR & INDUSTRIES

General Provider Information

NPI Number	:	1013956184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON D ZOOK MPT

Provider Business Mailing Address
First Line	:	1027 REGENTS BLVD
Second Line	:
City	:	FIRCREST
State	:	WA
Zip	:	98466-6030
Country	:	US
Telephone Number	:	253-202-6858
Fax Number	:

Provider Business Practice Location Address
First Line	:	1027 REGENTS BLVD
Second Line	:
City	:	FIRCREST
State	:	WA
Zip	:	98466-6030
Country	:	US
Telephone Number	:	253-202-6858
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	08/18/2010

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Directions to “ SHANNON D ZOOK MPT” Practice Location

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