Individual
SHANNON NICHOLLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
2150 E MAIN ST, WATERBURY, CT 06705-2608
(203) 598-0400
Mailing address
22 TOMPKINS STREET, WATERBURY, CT 06708-1458
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
13420
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004190328
—
CT
Enumeration date
02/09/2022
Last updated
02/09/2022
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