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General NPI Number Information
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NPI Number | 1285560995
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Entity Type | Individual
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Provider Name | SHANNON JACKSON
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Gender | Female
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Dates
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Enumeration Date | 06/20/2026
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Last Update Date | 06/20/2026
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Provider Practice Location Address
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Address Line | 8775 NORWIN AVE
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City | IRWIN
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State | PA
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Zip | 15642-2718
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Country | US
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Telephone | 724-861-7920
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Fax |
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Provider Business Mailing Address
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Address Line | 622 ALLEGHENY RIVER BLVD APT 4
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City | OAKMONT
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State | PA
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Zip | 15139-1554
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Country | US
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Telephone | 330-697-2952
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT034232
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License Number State | PA
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