Provider Demographics
NPI:1447477724
Name:DAVIE, SHANNON ASHLEY (PT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ASHLEY
Last Name:DAVIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:ASHLEY
Other - Last Name:SCHWIED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1727 2ND ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-8524
Mailing Address - Country:US
Mailing Address - Phone:941-951-0170
Mailing Address - Fax:941-993-1088
Practice Address - Street 1:1727 2ND ST STE 2
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-8524
Practice Address - Country:US
Practice Address - Phone:941-951-0170
Practice Address - Fax:941-993-1088
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT16994OtherFLORIDA LICENSE
FLPT16994OtherFLORIDA LICENSE
FLY7563VMedicare PIN