Provider Demographics
NPI:1497482699
Name:BEAN, SHAUN MATTHEW (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:MATTHEW
Last Name:BEAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6541 ZA ZU PITTS AVE UNIT 102
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-1704
Mailing Address - Country:US
Mailing Address - Phone:702-917-1517
Mailing Address - Fax:
Practice Address - Street 1:6823 PONDEROSA WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2100
Practice Address - Country:US
Practice Address - Phone:702-665-4054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4943OtherPHYSICAL THERAPIST LICENSE NUMBER