MEDICARE: DR. SHANNON ALEXANDRA AHEARN DPT

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	31297	AZ

General Provider Information

NPI Number	:	1811507304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON ALEXANDRA AHEARN DPT

Provider Business Mailing Address
First Line	:	14287 N 87TH ST STE 220
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-3698
Country	:	US
Telephone Number	:	602-329-8250
Fax Number	:	480-565-1898

Provider Business Practice Location Address
First Line	:	2301 E YEAGER DR STE 3
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85286-1578
Country	:	US
Telephone Number	:	480-351-8721
Fax Number	:	480-351-8722

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

Provider Enumeration Date	:	08/09/2020
Last Update Date	:	02/22/2022

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