Provider Demographics
NPI:1902784325
Name:FLYNN, SHANNON (PT, DPT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:FLYNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1658 N MILWAUKEE AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6905
Mailing Address - Country:US
Mailing Address - Phone:773-355-2812
Mailing Address - Fax:773-355-2844
Practice Address - Street 1:1658 N MILWAUKEE AVE UNIT 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-6905
Practice Address - Country:US
Practice Address - Phone:773-355-2812
Practice Address - Fax:773-355-2844
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070027293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist