Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mrs. Shannon Raye Roderique, LPTA

Individual provider Physical Therapy Assistant · NPI 1992405302

Mrs. Shannon Raye Roderique, LPTA is a Physical Therapy Assistant in O Fallon, Missouri. Practices as a sole proprietor. Registered with an NPI since 2023.

In the registry since
2023

Practice location Address checks out

7068 S Outer 364
O Fallon, MO 63368-7757
Phone: (636) 240-6100
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X

Record details

NPI number1992405302
Entity typeIndividual (Type 1)
GenderFemale
Credentials LPTA
Sole proprietorYes
NPI enumeratedMarch 6, 2023
Last updated in NPPESMarch 6, 2023
Certification dateMarch 4, 2023

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