Basic Information
Provider Information
NPI: 1003002387
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CRIADO
FirstName: SHANNON
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
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OtherCredential:  
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Mailing Information
Address1: 2617 RAYMILTON RD
Address2:  
City: UTICA
State: PA
PostalCode: 163621521
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 200 12TH ST
Address2:  
City: FRANKLIN
State: PA
PostalCode: 163231217
CountryCode: US
TelephoneNumber: 8144373071
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/19/2007
LastUpdateDate: 09/19/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT015949PAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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