Individual
SHANA GLENN POE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
36 S MAIN ST, STE B, TRAVELERS REST, SC 29690-1872
(864) 660-8200
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-9510
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6802
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TH2536
SC MEDICAID
SC
Enumeration date
09/04/2012
Last updated
11/09/2015
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