MEDICARE: SHANNON ELIZABETH BOOTH PT, 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	PT032744	PA

General Provider Information

NPI Number	:	1255159315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON ELIZABETH BOOTH PT, DPT

Provider Business Mailing Address
First Line	:	5000 BRANDT DR APT 5303
Second Line	:
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-6479
Country	:	US
Telephone Number	:	814-619-9339
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 BEAVER GRADE RD STE 120
Second Line	:
City	:	MOON TWP
State	:	PA
Zip	:	15108-2964
Country	:	US
Telephone Number	:	412-724-0964
Fax Number	:

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

Provider Enumeration Date	:	09/27/2024
Last Update Date	:	09/27/2024

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