Healthcare Provider Details

I. General information

NPI: 1902784325
Provider Name (Legal Business Name): SHANNON FLYNN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON FLYNN PT, DPT

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1658 N MILWAUKEE AVE UNIT 3
CHICAGO IL
60647-6905
US

IV. Provider business mailing address

1658 N MILWAUKEE AVE UNIT 3
CHICAGO IL
60647-6905
US

V. Phone/Fax

Practice location:
  • Phone: 773-355-2812
  • Fax: 773-355-2844
Mailing address:
  • Phone: 773-355-2812
  • Fax: 773-355-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070027293
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: