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NPI Code Detail

MEDICARE: SHANNON MAIXNER PT

MEDICARE: SHANNON MAIXNER PT
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
1225100000XPhysical Therapist
2225100000XPhysical Therapist4723MN

General Provider Information

NPI Number : 1861583379
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON MAIXNER PT
Provider Business Mailing Address
First Line : 688 WILDWOOD RD
Second Line :
City : MAHTOMEDI
State : MN
Zip : 55115-1812
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 688 WILDWOOD RD
Second Line :
City : MAHTOMEDI
State : MN
Zip : 55115-1812
Country : US
Telephone Number : 651-429-9947
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 03/11/2024

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Directions to “ SHANNON MAIXNER PT” Practice Location

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