Healthcare Provider Details

I. General information

NPI: 1740957372
Provider Name (Legal Business Name): SHANNON N GOLDING DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 S 72ND ST STE F
TACOMA WA
98408-1238
US

IV. Provider business mailing address

1702 S 72ND ST STE F
TACOMA WA
98408-1238
US

V. Phone/Fax

Practice location:
  • Phone: 253-475-6779
  • Fax: 253-475-7005
Mailing address:
  • Phone: 253-475-6779
  • Fax: 253-475-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT61191059
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: