Provider Demographics
NPI:1982586715
Name:REDDING, SHANNON MCDANIEL (PTA)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MCDANIEL
Last Name:REDDING
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3931 PRAIRIE CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-1787
Mailing Address - Country:US
Mailing Address - Phone:513-237-2744
Mailing Address - Fax:
Practice Address - Street 1:3931 PRAIRIE CLOVER LN
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-1787
Practice Address - Country:US
Practice Address - Phone:513-237-2744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2145166225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant