MEDICARE: MRS. SHANNON BLAKE MIDDLETON BS, MPT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT10466	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00395152	OTHER	OH	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245239078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON BLAKE MIDDLETON BS, MPT, DPT

Provider Business Mailing Address
First Line	:	1325 E KEMPER RD
Second Line	:	STE 100
City	:	CINCINNATI
State	:	OH
Zip	:	45246-3921
Country	:	US
Telephone Number	:	513-823-4247
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 E KEMPER RD
Second Line	:	STE 100
City	:	CINCINNATI
State	:	OH
Zip	:	45246-3921
Country	:	US
Telephone Number	:	513-823-4247
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	05/05/2016

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