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General NPI Number Information
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NPI Number | 1255060968
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Entity Type | Individual
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Provider Name | SHANNON NICOLE POSSARDT DPT, NCS
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Gender | Female
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 06/11/2024
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Provider Practice Location Address
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Address Line | 355 E ERIE ST
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City | CHICAGO
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State | IL
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Zip | 60611-3167
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Country | US
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Telephone | 312-238-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 654 W THOMAS ST
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City | ELMHURST
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State | IL
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Zip | 60126-3027
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Country | US
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Telephone | 630-709-2331
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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 | 2251N0400X
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Taxonomy Name | Neurology Physical Therapist
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License Number | 070.027276
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License Number State | IL
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