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General NPI Number Information
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NPI Number | 1023401148
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Entity Type | Individual
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Provider Name | SHANNON MICHELLE FLYNN ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 03/13/2015
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Last Update Date | 02/15/2018
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Provider Practice Location Address
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Address Line | 208 EDGEMONT BLVD
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City | ALAMOSA
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State | CO
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Zip | 81101-2320
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Country | US
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Telephone | 719-587-7011
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Fax |
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Provider Business Mailing Address
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Address Line | 42931 SAXONY RD
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City | CANTON
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State | MI
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Zip | 48187-2337
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT.0001767
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License Number State | CO
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