MEDICARE: SHANNON RAE BELCHER 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	225200000X	Physical Therapy Assistant	A01693	KY

General Provider Information

NPI Number	:	1508028184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON RAE BELCHER LPTA

Provider Business Mailing Address
First Line	:	134 MEADOW FRK
Second Line	:
City	:	MILLSTONE
State	:	KY
Zip	:	41838-9067
Country	:	US
Telephone Number	:	606-855-4883
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 MEADOW FRK
Second Line	:
City	:	MILLSTONE
State	:	KY
Zip	:	41838-9067
Country	:	US
Telephone Number	:	606-855-4883
Fax Number	:

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

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	06/25/2008

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