Provider Demographics
NPI:1780101550
Name:FRIEDERS, SHANNON MURPHY (PT, DPT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MURPHY
Last Name:FRIEDERS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:RITA
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1512 TALBOT AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-8428
Mailing Address - Country:US
Mailing Address - Phone:904-327-0754
Mailing Address - Fax:
Practice Address - Street 1:1512 TALBOT AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-8428
Practice Address - Country:US
Practice Address - Phone:904-327-0754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.023143225100000X
FL42946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist