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NPI Code Detail

MEDICARE: SHANNON CLEAR PTA

MEDICARE: SHANNON CLEAR PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant07651OH

General Provider Information

NPI Number : 1114271715
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON CLEAR PTA
Provider Business Mailing Address
First Line : 4444 ASPEN DR
Second Line :
City : LIBERTY TWP
State : OH
Zip : 45011-5210
Country : US
Telephone Number : 513-364-8499
Fax Number :
Provider Business Practice Location Address
First Line : 5435 KENWOOD RD # 45227
Second Line :
City : CINCINNATI
State : OH
Zip : 45227-1328
Country : US
Telephone Number : 513-271-1370
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2012
Last Update Date : 11/04/2012

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Directions to “ SHANNON CLEAR PTA” Practice Location

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