Healthcare Provider Details

I. General information

NPI: 1245756766
Provider Name (Legal Business Name): SHAYNA PATRICE BRANNON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAYNA MATOUSEK

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 DIXMYTH AVE
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

2051 WESTBOROUGH DR.
HEBRON KY
41048
US

V. Phone/Fax

Practice location:
  • Phone: 513-246-7458
  • Fax:
Mailing address:
  • Phone: 440-840-3811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017110
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT017110
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: