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NPI Code Detail

MEDICARE: MRS. SHANNON C ARDIS MPT

MEDICARE:  MRS. SHANNON C ARDIS  MPT
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
1225100000XPhysical Therapist4136SC

General Provider Information

NPI Number : 1912098021
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHANNON C ARDIS MPT
Provider Business Mailing Address
First Line : 401 2ND LOOP RD STE A
Second Line :
City : FLORENCE
State : SC
Zip : 29505-2815
Country : US
Telephone Number : 843-669-3665
Fax Number : 843-669-3706
Provider Business Practice Location Address
First Line : 401 N MAIN ST
Second Line : SUITE B
City : HEMINGWAY
State : SC
Zip : 29554-9191
Country : US
Telephone Number : 843-558-4830
Fax Number : 843-558-7752
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2006
Last Update Date : 08/25/2008

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Directions to “ MRS. SHANNON C ARDIS MPT” Practice Location

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