| NPI | 1962430264 |
|---|---|
| Former Name | SHANNON M GARDAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT10951) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT016707) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2008-12-03 |