MEDICARE: DR. VICTORIA SHANNON DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1294491	TX

General Provider Information

NPI Number	:	1063931418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTORIA SHANNON DPT

Provider Business Mailing Address
First Line	:	811 DRACENA CT
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-2857
Country	:	US
Telephone Number	:	979-248-1641
Fax Number	:

Provider Business Practice Location Address
First Line	:	16742 SOUTHWEST FWY STE 10
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-2331
Country	:	US
Telephone Number	:	346-788-1352
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2017
Last Update Date	:	01/26/2026

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