Provider Demographics
NPI:1447799341
Name:O'SHAUGHNESSY, SEAN (DPT)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:O'SHAUGHNESSY
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 1:210 COMMERCE WAY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-8200
Mailing Address - Country:US
Mailing Address - Phone:603-427-8066
Mailing Address - Fax:603-501-0495
Practice Address - Street 1:300 TRADECENTER
Practice Address - Street 2:SUITE 1650
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1883
Practice Address - Country:US
Practice Address - Phone:781-935-2655
Practice Address - Fax:781-935-9097
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA22859OtherLIC #