MEDICARE: DR. SHANNON DUMMETT DPT

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	7489	SC

General Provider Information

NPI Number	:	1396119418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON DUMMETT DPT

Provider Business Mailing Address
First Line	:	PSC 556
Second Line	:	BOX 683
City	:	FPO
State	:	AP
Zip	:	96386-0007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 556
Second Line	:	BOX 683
City	:	FPO
State	:	AP
Zip	:	96386-0007
Country	:	US
Telephone Number	:	08048799737
Fax Number	:

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

Provider Enumeration Date	:	12/01/2015
Last Update Date	:	12/01/2015

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Directions to “ DR. SHANNON DUMMETT DPT” Practice Location

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