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Individual

SHASTA KETCHAMCONNELLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DPT

Contact information

Practice address
508 S 1ST AVE, DANVILLE, IA 52623-9609
(319) 750-2799
Mailing address
508 S 1ST AVE, DANVILLE, IA 52623-9609
(319) 750-2799

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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