Provider Demographics
NPI:1578651642
Name:FINNEGAN, SHAWN EDWARD (PT)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:EDWARD
Last Name:FINNEGAN
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 1:5205 MECCA AVE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4119
Mailing Address - Country:US
Mailing Address - Phone:310-902-4060
Mailing Address - Fax:
Practice Address - Street 1:18300 TARZANA DR
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4216
Practice Address - Country:US
Practice Address - Phone:818-654-3097
Practice Address - Fax:818-654-3081
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist