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General NPI Number Information
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NPI Number | 1669101770
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Entity Type | Individual
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Provider Name | SHANNON DAWN HESTOR ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 06/06/2022
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 660 S 11TH ST
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City | INDIANA
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State | PA
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Zip | 17705
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Country | US
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Telephone | 717-991-3283
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Fax |
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Provider Business Mailing Address
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Address Line | 100 GROVE LN APT 813
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City | INDIANA
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State | PA
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Zip | 15701-2128
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Country | US
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Telephone | 717-991-3283
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | RT007852
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License Number State | PA
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