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Individual
MISS SHANTELL DUSTIN
Active
Individual
MISS SHANTELL DUSTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT, PTA, ATC
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
045013
NY
225200000X
Physical Therapy Assistant
008363-1
NY
2255A2300X
Athletic Trainer
001795
NY
Other
Enumeration date
04/16/2014
Last updated
07/19/2021
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