Provider Demographics
NPI:1710504469
Name:GONSER, SHELBY MARIE
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:MARIE
Last Name:GONSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 CITYGREEN WAY APT 102
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-1477
Mailing Address - Country:US
Mailing Address - Phone:517-231-2552
Mailing Address - Fax:
Practice Address - Street 1:5347 CHISHOLM CT APT A
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-4225
Practice Address - Country:US
Practice Address - Phone:517-231-2552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer