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Individual

SHANNON STEPHEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
521 MAIN ST, VAN BUREN, AR 72956-5109
(479) 410-1740
Mailing address
2111 BAINBRIDGE AVE, PONCA CITY, OK 74604-2404
(580) 765-0057

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
619
OK

Other

Enumeration date
06/26/2007
Last updated
07/08/2007
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