| Doctor Name: | SHANNON CUSTER |
| NPI Number: | 1013318203 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 12851-24 |
| Business Practice Address: | 4005 Westmark Dr Suite 320 Dubuque, IA - 520022271 |
| Business Phone Number: | 5635883891 |
| Business Fax Number: | 5635883893 |
| Mailing Address: | 4005 Westmark Dr, Suite 320 DUBUQUE |
| State: | IA |
| Postal Code: | 520022271 |
| Phone Number: | 5635883891 |
| Fax Number: | 5635883893 |
| NPI Enumeration Date: | 09/08/2014 |
| NPI Last Update Date: | 09/08/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 12851-24 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |