Basic Information
| Provider Information | |||||||||
| NPI: | 1164496899 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHANAHAN | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PT, ATC, CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 280 N RANDALL RD | ||||||||
| Address2: | |||||||||
| City: | LAKE IN THE HILLS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601565903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478548219 | ||||||||
| FaxNumber: | 8478548278 | ||||||||
| Practice Location | |||||||||
| Address1: | 280 N RANDALL RD | ||||||||
| Address2: | |||||||||
| City: | LAKE IN THE HILLS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601565903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478548219 | ||||||||
| FaxNumber: | 8478548278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 08/18/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 096001948 | IL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 225100000X | 070016588 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.