Provider Demographics
NPI:1508133976
Name:GALE, SHANNON (MPT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:GALE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:KOSLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-626-6161
Mailing Address - Fax:419-502-3511
Practice Address - Street 1:3365 RICHMOND RD
Practice Address - Street 2:STE 110
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4116
Practice Address - Country:US
Practice Address - Phone:216-593-7070
Practice Address - Fax:216-593-7074
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT012587225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist