Individual
SHAVAYA HARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
604 HIGHWAY 80 W STE R, CLINTON, MS 39056-4108
(601) 473-2106
Mailing address
PO BOX 701, CLINTON, MS 39060-0701
(601) 473-2106
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
225200000X
Physical Therapy Assistant
PTA 5698
MS
Other
Enumeration date
03/22/2016
Last updated
02/02/2021
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