Provider Demographics
NPI:1245756766
Name:BRANNON, SHAYNA PATRICE (DPT)
Entity Type:Individual
Prefix:DR
First Name:SHAYNA
Middle Name:PATRICE
Last Name:BRANNON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SHAYNA
Other - Middle Name:
Other - Last Name:MATOUSEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2051 WESTBOROUGH DR.
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:KY
Mailing Address - Zip Code:41048
Mailing Address - Country:US
Mailing Address - Phone:440-840-3811
Mailing Address - Fax:
Practice Address - Street 1:379 DIXMYTH AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2475
Practice Address - Country:US
Practice Address - Phone:513-246-7458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT0171102251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic