Healthcare Provider Details

I. General information

NPI: 1922925833
Provider Name (Legal Business Name): ZACKARY SHAUGHNESSY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3870 STADIUM WAY DEPT 2701
OGDEN UT
84408-2701
US

IV. Provider business mailing address

3870 STADIUM WAY DEPT 2701
OGDEN UT
84408-2701
US

V. Phone/Fax

Practice location:
  • Phone: 801-626-7712
  • Fax: 801-626-7264
Mailing address:
  • Phone: 801-626-7712
  • Fax: 801-626-7264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14289646-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: