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NPI Code Detail

MEDICARE: MRS. SHANNON KELLIE MCPHERSON DPT

MEDICARE: MRS. SHANNON KELLIE MCPHERSON 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
1225100000XPhysical TherapistPT3976ME

General Provider Information

NPI Number : 1851639298
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHANNON KELLIE MCPHERSON DPT
Provider Business Mailing Address
First Line : 388 CAPE RD
Second Line :
City : HOLLIS CENTER
State : ME
Zip : 04042-3712
Country : US
Telephone Number : 207-298-2651
Fax Number :
Provider Business Practice Location Address
First Line : 561 CONGRESS ST
Second Line :
City : PORTLAND
State : ME
Zip : 04101-3308
Country : US
Telephone Number : 207-536-4968
Fax Number : 207-213-4116
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2013
Last Update Date : 04/11/2024

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