MEDICARE: SHANNON ROSE NEALON P.T.

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
1	225100000X	Physical Therapist	2534	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00453826	OTHER	NE	MEDIARE RR

General Provider Information

NPI Number	:	1740316132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON ROSE NEALON P.T.

Provider Business Mailing Address
First Line	:	2403 S 133RD PLZ
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-5905
Country	:	US
Telephone Number	:	402-330-8433
Fax Number	:	402-330-8616

Provider Business Practice Location Address
First Line	:	2953 S 168TH ST
Second Line	:	SUITE 100
City	:	OMAHA
State	:	NE
Zip	:	68130-2000
Country	:	US
Telephone Number	:	402-593-7345
Fax Number	:	402-593-0882

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	04/02/2008

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Directions to “ SHANNON ROSE NEALON P.T.” Practice Location

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