Individual
SHANNON MCIVOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 WILSON LOOP, WARD, AR 72176
(501) 941-5630
Mailing address
15351 HIGHWAY 5, APT 227, CABOT, AR 72023
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT3261
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
183417721
—
AR
Enumeration date
10/13/2010
Last updated
10/13/2010
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