Individual
SHAWNERY DAVIDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
5408 MARYVILLE RD, GRANITE CITY, IL 62040-2611
(618) 581-8328
(708) 479-2112
Mailing address
5408 MARYVILLE RD, GRANITE CITY, IL 62040-2611
(618) 581-8328
(708) 479-2112
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160002824
IL
Other
Enumeration date
06/01/2016
Last updated
06/01/2016
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