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General NPI Number Information
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NPI Number | 1598996118
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Entity Type | Individual
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Provider Name | SHANNON NICOLE WILCOX PT
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Gender | Female
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Dates
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Enumeration Date | 07/30/2009
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Last Update Date | 08/11/2020
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Provider Practice Location Address
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Address Line | 2108 CATON WAY SW
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City | OLYMPIA
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State | WA
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Zip | 98502-1105
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Country | US
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Telephone | 360-352-1126
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Fax |
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Provider Business Mailing Address
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Address Line | 18504 BOTHELL WAY NE
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City | BOTHELL
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State | WA
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Zip | 98011-1927
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Country | US
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Telephone | 425-481-1933
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Fax | 425-481-9371
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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 | PT60099667
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License Number State | WA
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