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General NPI Number Information
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NPI Number | 1023811866
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Entity Type | Individual
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Provider Name | SHANNON ALENE EXUM
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Gender | Female
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Dates
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Enumeration Date | 03/28/2025
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 1410 N AUGUSTA ST
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City | STAUNTON
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State | VA
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Zip | 24401-2401
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Country | US
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Telephone | 540-886-6233
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Fax |
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Provider Business Mailing Address
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Address Line | 3902 LITTLE RIVER RD # 165
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City | ROCKFORD
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State | TN
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Zip | 37853-3346
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Country | US
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Telephone | 720-474-5543
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | CP043311A
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License Number State | VA
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