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General NPI Number Information
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NPI Number | 1952577983
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Entity Type | Individual
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Provider Name | MICHAEL JAMES SHANNON II PT
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Gender | Male
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 06/24/2020
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Provider Practice Location Address
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Address Line | 410 S MELROSE DR STE 200
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City | VISTA
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State | CA
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Zip | 92081-6623
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Country | US
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Telephone | 858-229-8178
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Fax |
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Provider Business Mailing Address
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Address Line | 4050 HARBOR DR
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City | CARLSBAD
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State | CA
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Zip | 92008-4113
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Country | US
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Telephone | 858-229-8178
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Fax | 877-575-2650
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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 | 27069
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License Number State | CA
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