Healthcare Provider Details

I. General information

NPI: 1700324241
Provider Name (Legal Business Name): SHANNON RUBENSTEIN KAPLAN PT, DPT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2017
Last Update Date: 02/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 E WILLIAMS ST SUITE #108
APEX NC
27539-7764
US

IV. Provider business mailing address

8020 ANGLE PARK DR APT 306
RALEIGH NC
27617-1890
US

V. Phone/Fax

Practice location:
  • Phone: 919-372-8412
  • Fax:
Mailing address:
  • Phone: 703-577-5525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP16918
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: