Shannon E Goodhue, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT011345 Issued in OH

Practice address

8087 Washington Village Dr Ste 101
Centerville, OH 45458-1873

Phone

(937) 938-8380

Fax

(937) 938-8392

NPI assigned

Oct 27, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Shannon Conlon Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282780800000",
    "number": "1275619009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8087 WASHINGTON VILLAGE DR STE 101",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454581873",
            "telephone_number": "937-938-8380",
            "fax_number": "937-938-8392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8087 WASHINGTON VILLAGE DR STE 101",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454581873",
            "telephone_number": "937-938-8380",
            "fax_number": "937-938-8392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODHUE",
        "first_name": "SHANNON",
        "middle_name": "E",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-27",
        "last_updated": "2010-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OH",
            "license": "PT011345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0108341",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BWC",
            "identifier": "382617193-30",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "000000190966",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "CONLON",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapist in Centerville, OH
• Providers in Centerville, OH by specialty
• Physical Therapist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.