Individual
SHANNON STACEY HARMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
251 FOREST LANE, MONTELLO, WI 53949
(608) 297-2153
Mailing address
N1250 34TH ROAD, BERLIN, WI 54923
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
87-019
WI
Other
Enumeration date
05/02/2007
Last updated
07/08/2007
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