Individual
SHANNON E GILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
6040 LUTE RD, PORTAGE, IN 46368-5008
(219) 763-6858
(219) 763-4858
Mailing address
8211 W 127TH AVE, CEDAR LAKE, IN 46303-8873
(219) 374-7157
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06001802A
IN
Other
Enumeration date
06/29/2007
Last updated
07/08/2007
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