Provider Demographics
NPI:1497898290
Name:MARGHERIO, SHANNON R (MPT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:R
Last Name:MARGHERIO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:R
Other - Last Name:FLURRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:2401 GILLHAM RD
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-701-5200
Mailing Address - Fax:816-302-9939
Practice Address - Street 1:1801 N 98TH STREET
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109
Practice Address - Country:US
Practice Address - Phone:913-717-4750
Practice Address - Fax:816-302-9939
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005026639225100000X
KS11-03534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
36176053OtherBCBS KC
KSKA2868022OtherMEDICARE PTAN
MOMA4370021OtherMEDICARE PTAN