Individual
MR. SAMUEL C SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
420B MCNULTY ST, BLYTHEWOOD, SC 29016-8786
(803) 728-0421
(803) 728-0424
Mailing address
420B MCNULTY ST, BLYTHEWOOD, SC 29016-8786
(803) 728-0421
(803) 728-0424
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
4846
SC
Other
Enumeration date
10/27/2022
Last updated
10/27/2022
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