Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2275 | SC |
NPI | 1013161918 |
---|---|
Provider Name | Miss Shakeila Janaiea Tyler |
First Address | North Augusta, SC 29860-9251 |
Second Address | North Augusta, SC 29860-9251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2008 |
Last Update Date | 05/11/2008 |