Individual
SHEENA M FANTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2120 ENTERPRISE DR, SUITE A, BILOXI, MS 39531-4039
(228) 702-0882
(228) 702-0082
Mailing address
PO BOX 8419, BILOXI, MS 39535-8087
(228) 388-5714
(228) 388-0017
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT4597
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015077
—
MS
01
—
1033218524
GROUP NPI
MS
Enumeration date
12/14/2009
Last updated
12/14/2009
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