Individual
SHAWNA ROSE HARDISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
210 BROOKSIDE DRIVE, MADILL, OK 73446
(580) 795-2100
Mailing address
PO BOX 831, MADILL, OK 73446-0831
(580) 795-3301
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1263
OK
Other
Enumeration date
03/09/2007
Last updated
07/08/2007
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