Basic Information
| Provider Information | |||||||||
| NPI: | 1033738679 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIERS | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | LOUISE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 118 | ||||||||
| Address2: | |||||||||
| City: | AMANA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522030118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193100989 | ||||||||
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| Practice Location | |||||||||
| Address1: | UI SPORTS MEDICINE (IOSMR) | ||||||||
| Address2: | 2701 PRAIRIE MEADOW DRIVE | ||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 52242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193847070 | ||||||||
| FaxNumber: | 3194678247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2020 | ||||||||
| LastUpdateDate: | 04/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251S0007X | 03713 | IA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports |
No ID Information.