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Individual
MRS. SHANNON BLAKE MIDDLETON
Active
Individual
MRS. SHANNON BLAKE MIDDLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS, MPT, DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT10466
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2565988
—
OH
01
—
P00395152
MEDICARE RAILROAD
OH
Enumeration date
07/14/2005
Last updated
05/05/2016
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