Provider Demographics
NPI:1760760722
Name:SHANNON, JEAN M (PT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:SHANNON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:M
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5557 CHEVIOT RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7020
Mailing Address - Country:US
Mailing Address - Phone:513-923-1700
Mailing Address - Fax:513-741-6631
Practice Address - Street 1:5557 CHEVIOT RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-7020
Practice Address - Country:US
Practice Address - Phone:513-923-1700
Practice Address - Fax:513-741-6631
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH026402251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0779171Medicaid
OH366642OtherMEDICARE