Provider Demographics
NPI:1407927882
Name:OCONNOR, SHAUN R (PT)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:R
Last Name:OCONNOR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 HINESBURG RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7621
Mailing Address - Country:US
Mailing Address - Phone:802-864-0015
Mailing Address - Fax:802-863-4988
Practice Address - Street 1:1050 HINESBURG RD
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7621
Practice Address - Country:US
Practice Address - Phone:802-864-0015
Practice Address - Fax:802-863-4988
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5206001OtherVMC GMI
43V010OtherMVP
06528695OtherBLUE CROSS
VTVN1957Medicare ID - Type Unspecified