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Individual
MR. SHANNON MICHAEL WALTON
Active
Individual
MR. SHANNON MICHAEL WALTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10570
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
64-00320
UNITED HEALTH
MA
01
—
689253
TUFTS
MA
01
—
AA43298
HARVARD PILGRIM
MA
01
—
Y67408
BLUE CROSS BLUE SHIELD
MA
Enumeration date
08/23/2006
Last updated
07/08/2007
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