Provider Demographics
NPI:1902020605
Name:PAOPAO, SHANNA J (PT)
Entity Type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:J
Last Name:PAOPAO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 N 150TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-6183
Mailing Address - Country:US
Mailing Address - Phone:402-709-0803
Mailing Address - Fax:
Practice Address - Street 1:2504 S 119TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2947
Practice Address - Country:US
Practice Address - Phone:402-932-8686
Practice Address - Fax:402-932-8677
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1843225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist