Individual
CHARLES SHANESY III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
3817 COLONEL GLENN HWY, BEAVERCREEK, OH 45324
(937) 427-9200
(513) 755-3762
Mailing address
7591 TYLERS PLACE BLVD, WEST CHESTER, OH 45069-6308
(513) 755-6600
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2187155
—
OH
01
—
AB7360731
MEDICARE PIN
OH
Enumeration date
10/14/2016
Last updated
08/22/2019
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