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General NPI Number Information
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NPI Number | 1992622724
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Entity Type | Individual
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Provider Name | SHANNON GAMBON PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 07/02/2026
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Last Update Date | 07/02/2026
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Provider Practice Location Address
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Address Line | 3910 16TH ST
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City | MOLINE
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State | IL
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Zip | 61265-1275
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Country | US
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Telephone | 309-581-7640
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Fax | 309-382-8069
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Provider Business Mailing Address
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Address Line | 3109 15TH ST
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City | ROCK ISLAND
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State | IL
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Zip | 61201-6111
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Country | US
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Telephone | 309-581-7640
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Fax | 309-382-8069
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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 | 070.023187
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License Number State | IL
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