MEDICARE: SHANNON M ELQORCHI

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		PA

General Provider Information

NPI Number	:	1447543301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON M ELQORCHI

Provider Business Mailing Address
First Line	:	100 WALTER WARD BLVD STE 200
Second Line	:
City	:	ABINGDON
State	:	MD
Zip	:	21009-1285
Country	:	US
Telephone Number	:	443-512-8337
Fax Number	:

Provider Business Practice Location Address
First Line	:	11711 LIVINGSTON RD STE 200
Second Line	:
City	:	FT WASHINGTON
State	:	MD
Zip	:	20744-5151
Country	:	US
Telephone Number	:	443-512-8337
Fax Number	:	443-327-5282

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

Provider Enumeration Date	:	05/25/2011
Last Update Date	:	05/06/2024

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