Provider Demographics
NPI:1841667946
Name:DENNIS, SHAUN CAMERON (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:CAMERON
Last Name:DENNIS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-7739
Mailing Address - Country:US
Mailing Address - Phone:937-638-0354
Mailing Address - Fax:419-738-8002
Practice Address - Street 1:610 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-7739
Practice Address - Country:US
Practice Address - Phone:673-564-3855
Practice Address - Fax:419-738-8002
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT016035225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist