Provider Demographics
NPI:1861970568
Name:BYERS, SHANNON (DPT)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:BYERS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:TOMASELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:84 THOMAS JOHNSON CT STE B
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4678
Mailing Address - Country:US
Mailing Address - Phone:301-662-8541
Mailing Address - Fax:301-662-8762
Practice Address - Street 1:84 THOMAS JOHNSON CT STE B
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4678
Practice Address - Country:US
Practice Address - Phone:301-662-8541
Practice Address - Fax:301-662-8762
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist