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Individual
SHASTA KETCHAMCONNELLY
Active
Individual
SHASTA KETCHAMCONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
080290
IA
225100000X
Physical Therapist
Primary
1221789
TX
225100000X
Physical Therapist
3843
HI
225100000X
Physical Therapist
871828
DC
Other
Enumeration date
06/21/2016
Last updated
06/21/2016
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