Provider Demographics
NPI:1386290534
Name:TEVENAN, SHANNON ERIKA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:ERIKA
Last Name:TEVENAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 CYPRESS ST
Mailing Address - Street 2:STE 110
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6777
Mailing Address - Country:US
Mailing Address - Phone:617-860-6430
Mailing Address - Fax:617-731-4162
Practice Address - Street 1:235 CYPRESS ST STE 110
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-6777
Practice Address - Country:US
Practice Address - Phone:617-860-6430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist