Individual
SHAWNA BLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
945 22ND ST, SAN LEON, TX 77539-7211
(832) 385-0338
Mailing address
945 22ND ST, SAN LEON, TX 77539
(832) 385-0338
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2075727
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2075727
STATE LICENSE
TX
Enumeration date
09/09/2010
Last updated
01/19/2024
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