MEDICARE: DR. SHAUN CAMERON DENNIS PT, 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	PT016035	OH

General Provider Information

NPI Number	:	1841667946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAUN CAMERON DENNIS PT, DPT

Provider Business Mailing Address
First Line	:	610 N DIXIE HWY
Second Line	:
City	:	WAPAKONETA
State	:	OH
Zip	:	45895-7739
Country	:	US
Telephone Number	:	937-638-0354
Fax Number	:	419-738-8002

Provider Business Practice Location Address
First Line	:	610 N DIXIE HWY
Second Line	:
City	:	WAPAKONETA
State	:	OH
Zip	:	45895-7739
Country	:	US
Telephone Number	:	673-564-3855
Fax Number	:	419-738-8002

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

Provider Enumeration Date	:	08/25/2015
Last Update Date	:	01/30/2020

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