Basic Information
| Provider Information | |||||||||
| NPI: | 1326793977 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LANGWORTHY | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 LAFAYETTE CT | ||||||||
| Address2: | |||||||||
| City: | BARNEGAT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080051204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093845275 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4617 W 20TH ST UNIT A | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806343207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703529022 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2022 | ||||||||
| LastUpdateDate: | 02/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | PTL.0018125 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.