Individual
SHANNON MULLANEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
5342 W WINONA ST, CHICAGO, IL 60630-2241
(773) 727-2070
Mailing address
5342 W WINONA ST, CHICAGO, IL 60630-2241
(773) 727-2070
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.005948
IL
Other
Enumeration date
07/02/2013
Last updated
07/02/2013
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