Healthcare Provider Details

I. General information

NPI: 1457469033
Provider Name (Legal Business Name): SHAWN M HANRAHAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 EGG HARBOR RD STE 152
STURGEON BAY WI
54235-1248
US

IV. Provider business mailing address

323 S 18TH AVE
STURGEON BAY WI
54235-1401
US

V. Phone/Fax

Practice location:
  • Phone: 920-746-0410
  • Fax:
Mailing address:
  • Phone: 920-743-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number372-19
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number535-046
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: