Provider Demographics
NPI:1457836850
Name:GERMAN, SHANNA MARIE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:SHANNA
Middle Name:MARIE
Last Name:GERMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12530 DELANEY RD
Mailing Address - Street 2:
Mailing Address - City:SPENCERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45887-9636
Mailing Address - Country:US
Mailing Address - Phone:419-516-2814
Mailing Address - Fax:
Practice Address - Street 1:800 AMBROSE DR
Practice Address - Street 2:
Practice Address - City:DELPHOS
Practice Address - State:OH
Practice Address - Zip Code:45833-9146
Practice Address - Country:US
Practice Address - Phone:419-692-0590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10171225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant