Shannon Kristine Pemble
Physical Therapist in Charlevoix, MI. Individual provider (NPI-1).
NPI number1942701909
StatusActive
Last updated in NPPESFeb 26, 2018
Details
- NPI
- 1942701909
- Entity type
- Individual (NPI-1)
- Name
- Shannon Kristine Pemble
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Feb 26, 2018
- Last updated
- Feb 26, 2018
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225100000X | Physical Therapist | 5501010622 | MI | Yes |
Practice location
14700 Lake Shore DriveRehab Dept
Charlevoix, MI 49720
Phone 231-547-8630 · Fax 231-547-8078
Mailing address
14700 Lake Shore DriveRehab Dept
Charlevoix, MI 49720
Phone 231-547-8630 · Fax 231-547-8078
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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