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General NPI Number Information
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NPI Number | 1649948100
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Entity Type | Individual
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Provider Name | SHANNON ELAINE BETTINGER
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Gender | Female
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 4 WATER ST
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City | BOSTON
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State | MA
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Zip | 02109-3503
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Country | US
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Telephone | 857-277-0923
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Fax | 844-912-8606
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Provider Business Mailing Address
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Address Line | 4 RICHMOND SQ
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City | PROVIDENCE
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State | RI
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Zip | 02906-5117
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Country | US
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Telephone | 401-433-4172
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Fax | 401-433-0612
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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 | PTL27535
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License Number State | MA
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