Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | 1401 | NC |
Y | 225200000X | Physical Therapy Assistant | 1413 | SC |
NPI | 1013033745 |
---|---|
Provider Name | Mrs. Shannon Leigh Ely |
First Address | Charlotte, NC 28210-6512 |
Second Address | Rock Hill, SC 29732-2415 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 08/07/2007 |