Provider Demographics
NPI:1336156835
Name:MCLEAN, SHANNON M (PT)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:M
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:M
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1220 E MESQUITE ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1902
Mailing Address - Country:US
Mailing Address - Phone:602-751-5328
Mailing Address - Fax:480-376-0464
Practice Address - Street 1:1220 E MESQUITE ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1902
Practice Address - Country:US
Practice Address - Phone:602-751-5328
Practice Address - Fax:480-376-0464
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5220225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist