Provider Demographics
NPI:1841526258
Name:O'CONNELL, SHAWN J (DPT)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:J
Last Name:O'CONNELL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12121 HARBOUR REACH DR
Mailing Address - Street 2:BUILDING A - STE 100
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5314
Mailing Address - Country:US
Mailing Address - Phone:425-493-8313
Mailing Address - Fax:425-493-9614
Practice Address - Street 1:10505 19TH AVE SE
Practice Address - Street 2:STE B
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4280
Practice Address - Country:US
Practice Address - Phone:408-570-0510
Practice Address - Fax:408-945-4018
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2012-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPT60100585225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8894942OtherMEDICARE