Provider Demographics
NPI:1255672762
Name:MCGANN, SHANNON M (PT)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:M
Last Name:MCGANN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363A MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1729
Mailing Address - Country:US
Mailing Address - Phone:650-599-9482
Mailing Address - Fax:650-599-9788
Practice Address - Street 1:363A MAIN ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1729
Practice Address - Country:US
Practice Address - Phone:650-599-9482
Practice Address - Fax:650-599-9788
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT187080225100000X
CA18780225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist