| NPI | 1043441017 |
|---|---|
| Former Name | JESSICA LYNN SHANAHAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: CO 16832) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT9710) |
| Enumeration Date | 2009-08-07 |
| Last Update Date | 2020-04-07 |