Provider Demographics
NPI:1053979641
Name:JONES, SHANNON FAITH (DPT, ATC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:FAITH
Last Name:JONES
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HEALTHCARE DR
Mailing Address - Street 2:
Mailing Address - City:PHILIPPI
Mailing Address - State:WV
Mailing Address - Zip Code:26416-9405
Mailing Address - Country:US
Mailing Address - Phone:304-457-1760
Mailing Address - Fax:304-457-1516
Practice Address - Street 1:1 HEALTHCARE DR
Practice Address - Street 2:
Practice Address - City:PHILIPPI
Practice Address - State:WV
Practice Address - Zip Code:26416-9405
Practice Address - Country:US
Practice Address - Phone:304-457-1760
Practice Address - Fax:304-457-1516
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV004016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist