Individual
SHANNON ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
175 BURDETTE ST, SPARTANBURG, SC 29307-1003
(864) 596-8491
Mailing address
1271 BETHESDA RD, SPARTANBURG, SC 29302-5710
(864) 590-1542
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1346
SC
Other
Enumeration date
12/24/2015
Last updated
12/24/2015
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