Provider Demographics
NPI:1538276548
Name:GRIFFIN, SHANNON HELTON (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:HELTON
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-0217
Mailing Address - Country:US
Mailing Address - Phone:434-447-3322
Mailing Address - Fax:
Practice Address - Street 1:1187 NORTH MECKLENBURG AVENUE
Practice Address - Street 2:
Practice Address - City:LACROSSE
Practice Address - State:VA
Practice Address - Zip Code:23950
Practice Address - Country:US
Practice Address - Phone:434-447-3322
Practice Address - Fax:434-447-3282
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00402089OtherRR MEDICARE ID
002105I97Medicare ID - Type Unspecified