Individual
SHANNON GOLTL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
2500 OLD HIGHWAY 63 S APT 7113, COLUMBIA, MO 65201-2203
(720) 829-7575
Mailing address
5306 SILVER MILL DR, COLUMBIA, MO 65202-6593
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000038556
MO
Other
Enumeration date
01/31/2019
Last updated
06/28/2020
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