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Individual
SHANNON E GOODHUE
Active
Individual
SHANNON E GOODHUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT011345
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000190966
BC/BS
OH
05
—
0108341
—
OH
01
—
382617193-30
BWC
OH
Enumeration date
10/27/2006
Last updated
08/26/2010
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