Provider Demographics
NPI:1033738679
Name:MIERS, SHANNON LOUISE
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:LOUISE
Last Name:MIERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:AMANA
Mailing Address - State:IA
Mailing Address - Zip Code:52203-0118
Mailing Address - Country:US
Mailing Address - Phone:319-310-0989
Mailing Address - Fax:
Practice Address - Street 1:UI SPORTS MEDICINE (IOSMR)
Practice Address - Street 2:2701 PRAIRIE MEADOW DRIVE
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242
Practice Address - Country:US
Practice Address - Phone:319-384-7070
Practice Address - Fax:319-467-8247
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA037132251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports