Individual
MARSHA SHACKELFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
100 A LINDSEY LANE, KINGSLAND, GA 31548
(912) 729-1333
(912) 729-5259
Mailing address
PO BOX 949, ROME, GA 30162-0949
(706) 802-1991
(706) 802-1408
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT009567
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
523966767A,B,C,D
—
GA
Enumeration date
02/25/2009
Last updated
05/14/2009
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