Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 532 | SC |
NPI | 1093267403 |
---|---|
Provider Name | Shannon Edwards Galloway |
First Address | Clemson, SC 29631-2194 |
Second Address | Clemson, SC 29631-2194 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2016 |
Last Update Date | 02/11/2016 |