Healthcare Provider Details

I. General information

NPI: 1225374200
Provider Name (Legal Business Name): SHANNON L CHABITNOY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON L POTOCNY

II. Dates (important events)

Enumeration Date: 12/20/2012
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W LEMON ST
LITITZ PA
17543-2311
US

IV. Provider business mailing address

327 BRICKER LN
LEBANON PA
17042-4109
US

V. Phone/Fax

Practice location:
  • Phone: 717-626-0214
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018295
License Number StatePA

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: