Healthcare Provider Details

I. General information

NPI: 1154850998
Provider Name (Legal Business Name): SHANNON MARCELLA CHAPMAN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 FORDHAM DR STE 102
FAYETTEVILLE NC
28304-3774
US

IV. Provider business mailing address

1991 FORDHAM DR STE 102
FAYETTEVILLE NC
28304-3774
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-4653
  • Fax: 910-483-9256
Mailing address:
  • Phone: 910-484-4653
  • Fax: 910-483-9256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305211601
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP17180
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: