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General NPI Number Information
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NPI Number | 1003818253
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Entity Type | Individual
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Provider Name | SHANNON O'HAGAN PT
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Gender | Female
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1920 CORDELL CT
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City | EL CAJON
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State | CA
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Zip | 92020-0900
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Country | US
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Telephone | 619-258-7497
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Fax | 619-258-7260
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Provider Business Mailing Address
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Address Line | 4763 LAMONT ST
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City | SAN DIEGO
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State | CA
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Zip | 92109-3420
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 27227
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License Number State | CA
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