Individual
SHANICE C PETTIGREW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
661 HIGHWAY 64B, WYNNE, AR 72396-8506
(870) 238-7038
Mailing address
9992 HIGHWAY 1 N, COLT, AR 72326-8408
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA4462
AR
Other
Enumeration date
08/01/2019
Last updated
08/01/2019
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