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NPI Code Detail

MEDICARE: SHANNON JOHNSON P.T.

MEDICARE:   SHANNON  JOHNSON  P.T.
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
1225100000XPhysical Therapist5181SC

General Provider Information

NPI Number : 1104931435
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON JOHNSON P.T.
Provider Business Mailing Address
First Line : 140 EXECUTIVE DR
Second Line :
City : GREER
State : SC
Zip : 29651-1200
Country : US
Telephone Number : 864-801-8706
Fax Number : 864-848-7203
Provider Business Practice Location Address
First Line : 140 EXECUTIVE DR
Second Line :
City : GREER
State : SC
Zip : 29651-1200
Country : US
Telephone Number : 864-801-8706
Fax Number : 864-848-7203
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2006
Last Update Date : 02/23/2021

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Directions to “ SHANNON JOHNSON P.T.” Practice Location

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