MEDICARE: KARI RENEE SHANNON PTA

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	225200000X	Physical Therapy Assistant	06003470A	IN

General Provider Information

NPI Number	:	1396950861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARI RENEE SHANNON PTA

Provider Business Mailing Address
First Line	:	2943 CARSON DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-3903
Country	:	US
Telephone Number	:	317-363-4696
Fax Number	:

Provider Business Practice Location Address
First Line	:	8711 US 31 S
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-6252
Country	:	US
Telephone Number	:	317-888-2560
Fax Number	:

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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Directions to “ KARI RENEE SHANNON PTA” Practice Location

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