Provider Demographics
NPI:1770619595
Name:COONEY, SHAWN PATRICK (MPT, CMP)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:PATRICK
Last Name:COONEY
Suffix:
Gender:M
Credentials:MPT, CMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 NE 82ND CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-4092
Mailing Address - Country:US
Mailing Address - Phone:503-348-5174
Mailing Address - Fax:
Practice Address - Street 1:3108 NE 181ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-6926
Practice Address - Country:US
Practice Address - Phone:503-489-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR38172251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic