Individual
SHANNON L WHEATON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4 HAWTHORNE DR, BEDFORD, NH 03110-6912
(603) 472-8888
(603) 472-9090
Mailing address
4 HAWTHORNE DR, BEDFORD, NH 03110-6912
(603) 472-8888
(603) 472-9090
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2263
NH
2251X0800X
Orthopedic Physical Therapist
Primary
2263
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0804453Y0NH01
ANTHEM
NH
01
—
1073627329
GROUP NPI
—
01
—
225543
CIGNA
NH
Enumeration date
09/28/2006
Last updated
11/26/2007
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