Provider Demographics
NPI:1689934317
Name:SHOUP, DEAN A (LMT)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:A
Last Name:SHOUP
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1368 KEYRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-2221
Mailing Address - Country:US
Mailing Address - Phone:513-680-8654
Mailing Address - Fax:513-851-8654
Practice Address - Street 1:2766 MACK RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5129
Practice Address - Country:US
Practice Address - Phone:513-942-2500
Practice Address - Fax:513-942-7999
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.019427 S172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH33.019427 SOtherSTATE MEDICAL BOARD OF OHIO