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Individual

MRS. SHAWN GRAY ELLISON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHYSICAL THERAPIST

Contact information

Practice address
1132 RUTHERFORD RD, GREENVILLE, SC 29609-3927
(864) 250-0005
(864) 250-0028
Mailing address
1132 RUTHERFORD RD, GREENVILLE, SC 29609-3927
(864) 250-0005
(864) 250-0028

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1122
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1122
S.C. LICENSE
SC
Enumeration date
10/15/2010
Last updated
10/15/2010
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