Provider Demographics
NPI:1194806810
Name:FLANNAGAN, SEAN O'TOOLE (DPT)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:O'TOOLE
Last Name:FLANNAGAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12264
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85230-2264
Mailing Address - Country:US
Mailing Address - Phone:520-836-8621
Mailing Address - Fax:
Practice Address - Street 1:520 N CAMINO MERCADO
Practice Address - Street 2:SUITE 1
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-5754
Practice Address - Country:US
Practice Address - Phone:520-836-8621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ78970Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #