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Individual
JEAN M SHANNON
Active
Individual
JEAN M SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
02640
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0779171
—
OH
01
—
366642
MEDICARE
OH
Enumeration date
07/25/2011
Last updated
07/25/2011
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