Individual
MACKENZIE GRACE SHIELDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4419 TRAM RD, PANAMA CITY, FL 32404-2559
(850) 747-5401
Mailing address
1089 OVERPASS RD, COTTONDALE, FL 32431-8943
(850) 718-7624
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTAT33491
FL
Other
Enumeration date
06/03/2024
Last updated
06/03/2024
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