Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 9521 | AZ |
NPI | 1528343894 |
---|---|
Provider Name | Shannon J Jameson |
First Address | Phoenix, AZ 85014-2734 |
Second Address | Phoenix, AZ 85014-2734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2011 |
Last Update Date | 18/10/2011 |