Individual
MRS. SHANNON LEIGH STOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.A.
Contact information
Practice address
1400 8TH AVE, FORT WORTH, TX 76104-4110
(817) 922-7105
Mailing address
1400 8TH AVE, FORT WORTH, TX 76104-4110
(817) 922-7105
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2039105
TX
Other
Enumeration date
04/22/2011
Last updated
04/22/2011
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