Individual
SHANNON E BROCKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
401 W MARTINTOWN RD, SUITE 169, NORTH AUGUSTA, SC 29841-3194
(803) 441-0025
Mailing address
401 W MARTINTOWN RD, SUITE 169, NORTH AUGUSTA, SC 29841-3194
(803) 441-0025
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 002671
GA
225200000X
Physical Therapy Assistant
PTA 2460
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116819
MEDICARE REHABILITATION AGENCY CERTIFICATION NUMBER
GA
01
—
426619
MEDICARE REHABILITATION AGENCY CERTIFICATION NUMBER
SC
Enumeration date
01/28/2010
Last updated
04/19/2010
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