Individual
DEANDRE KELLY SHANESE SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
8477 S SUNCOAST BLVD, HOMOSASSA, FL 34446-5028
(352) 448-7857
(352) 382-7781
Mailing address
8477 S SUNCOAST BLVD, HOMOSASSA, FL 34446-5028
(352) 448-7857
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT36881
FL
Other
Enumeration date
06/07/2021
Last updated
06/07/2021
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