Healthcare Provider Details

I. General information

NPI: 1164496899
Provider Name (Legal Business Name): KAREN A SHANAHAN PT, ATC, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 N RANDALL RD
LAKE IN THE HILLS IL
60156-5903
US

IV. Provider business mailing address

280 N RANDALL RD
LAKE IN THE HILLS IL
60156-5903
US

V. Phone/Fax

Practice location:
  • Phone: 847-854-8219
  • Fax: 847-854-8278
Mailing address:
  • Phone: 847-854-8219
  • Fax: 847-854-8278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096001948
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070016588
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: