Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PTA13831 | FL |
NPI | 1023384575 |
---|---|
Provider Name | Shelley Marie Harrell |
First Address | Hudson, FL 34669-2842 |
Second Address | Hudson, FL 34669-2842 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2012 |
Last Update Date | 29/03/2012 |