Brockwell, Shannon E

Brockwell, Shannon E is an individual health care provider with primary practice located at 401 W Martintown Rd Suite 169, North Augusta SC 29841-3194. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant, which is considered as her primary health care specialty. Brockwell, Shannon E can be contacted via phone (803) 441-0025.

Contact Information

Primary practice address
401 W Martintown Rd Suite 169 North Augusta SC 29841-3194
Phone: (803) 441-0025
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant 225200000X PTA 002671 Georgia
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant 225200000X PTA 2460 South Carolina

Profile Details

NPI number 1083945216
LBN Legal business name Brockwell, Shannon E
Credentials Physical Therapist Assistant (PTA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 28th, 2010
Last updated Apr 19th, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083945216 NPPES
Georgia Other 116819 MEDICARE REHABILITATION AGENCY CERTIFICATION NUMBER
Georgia Other 426619 MEDICARE REHABILITATION AGENCY CERTIFICATION NUMBER

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