Individual
SHAWNA ELISA BENNER-ERICKSON
Active
Individual
SHAWNA ELISA BENNER-ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 1783
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010152747
BLUE SHIELD
ID
01
—
TD256
BLUECROSS# IN GROUP 8M558
ID
Enumeration date
02/27/2007
Last updated
07/09/2007
Update your record
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