Healthcare Provider Details

I. General information

NPI: 1457946329
Provider Name (Legal Business Name): SHANNON ZARNOSKI PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 03/03/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 W SPROUL RD
SPRINGFIELD PA
19064-2027
US

IV. Provider business mailing address

4180 MARIANNE DR
BROOKHAVEN PA
19015-1510
US

V. Phone/Fax

Practice location:
  • Phone: 610-328-8800
  • Fax:
Mailing address:
  • Phone: 484-437-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberTE006074
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: