MEDICARE: MR. SHAWN PATRICK COONEY M.P.T., C.M.P.

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	2251X0800X	Orthopedic Physical Therapist	3817	OR

General Provider Information

NPI Number	:	1770619595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAWN PATRICK COONEY M.P.T., C.M.P.

Provider Business Mailing Address
First Line	:	1502 NE 82ND CT
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98664-4092
Country	:	US
Telephone Number	:	503-348-5174
Fax Number	:

Provider Business Practice Location Address
First Line	:	3108 NE 181ST AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97230-6926
Country	:	US
Telephone Number	:	503-489-1990
Fax Number	:

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. SHAWN PATRICK COONEY M.P.T., C.M.P.” Practice Location

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