MEDICARE: SHANA LYNN BELL LPTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	PTA3102	MS
2	261QP2000X	Physical Therapy Clinic/Center
3	225200000X	Physical Therapy Assistant	PTA3102	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417094095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANA LYNN BELL LPTA

Provider Business Mailing Address
First Line	:	5 NORTHSIDE DR
Second Line	:
City	:	BELMONT
State	:	MS
Zip	:	38827-9201
Country	:	US
Telephone Number	:	662-416-1049
Fax Number	:	662-284-9866

Provider Business Practice Location Address
First Line	:	127 PRATT DR
Second Line	:
City	:	CORINTH
State	:	MS
Zip	:	38834-6026
Country	:	US
Telephone Number	:	662-284-9838
Fax Number	:	662-284-9866

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	04/07/2020

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