Individual
SHANE MICHAEL ANTHONY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1025 E WEST CONNECTOR, STE. 406, AUSTELL, GA 30106-8513
(770) 384-1001
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA000604
GA
Other
Enumeration date
09/01/2011
Last updated
09/09/2011
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