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General NPI Number Information
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NPI Number | 1699812800
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Entity Type | Individual
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Provider Name | BARBARA SHANNON
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Gender | Female
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 03/14/2017
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Provider Practice Location Address
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Address Line | 5757 WHITMORE LAKE RD STE 900
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City | BRIGHTON
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State | MI
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Zip | 48116-1962
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Country | US
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Telephone | 810-220-5793
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Fax | 810-220-5805
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Provider Business Mailing Address
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Address Line | 5757 WHITMORE LAKE RD STE 900
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City | BRIGHTON
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State | MI
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Zip | 48116-1962
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Country | US
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Telephone | 810-220-5793
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Fax | 810-220-5805
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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 | 5501002932
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License Number State | MI
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