Individual
MR. CRAIG D SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
11143 PARKVIEW PLAZA DR STE 100, FORT WAYNE, IN 46845-1728
(260) 266-7400
(260) 266-7439
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05005506A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200362950
—
IN
Enumeration date
11/29/2006
Last updated
02/10/2021
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