Provider Demographics
NPI:1245776129
Name:FLANAGAN, SEAN PATRICK (ATC)
Entity Type:Individual
Prefix:PROF
First Name:SEAN
Middle Name:PATRICK
Last Name:FLANAGAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3069 ZIRON AVE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-0507
Mailing Address - Country:US
Mailing Address - Phone:818-256-7773
Mailing Address - Fax:
Practice Address - Street 1:CALIFORNIA STATE UNIVERSITY NORTHRIDGE
Practice Address - Street 2:18111 NORDHHOFF STREET
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91330-8287
Practice Address - Country:US
Practice Address - Phone:818-677-7507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer