Provider Demographics
NPI:1629380811
Name:HARRAHILL, SHAWN MICHAEL (DPT)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:MICHAEL
Last Name:HARRAHILL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:8901 W DODGE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3327
Practice Address - Country:US
Practice Address - Phone:402-354-8980
Practice Address - Fax:402-354-8992
Is Sole Proprietor?:No
Enumeration Date:2010-07-05
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2879225100000X
IA004610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026056700Medicaid
NE10025896000Medicaid
NE10025896100Medicaid
NE10025941700Medicaid
IA1629380811Medicaid
NE10025895900Medicaid
NE10026252200Medicaid
NE099099020Medicare PIN