Healthcare Provider Details

I. General information

NPI: 1831481787
Provider Name (Legal Business Name): DAVID SHANNON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 BAHAMA DR
DALLAS TX
75211-2121
US

IV. Provider business mailing address

1808 MILLER DR
LAWRENCE KS
66044-4352
US

V. Phone/Fax

Practice location:
  • Phone: 214-948-3811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: