Healthcare Provider Details

I. General information

NPI: 1982307591
Provider Name (Legal Business Name): SHANE MORRIS PTA, BS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3845 SE LAKE WEIR AVE
OCALA FL
34480-9153
US

IV. Provider business mailing address

5721 NW 59TH AVE
OCALA FL
34482-2735
US

V. Phone/Fax

Practice location:
  • Phone: 352-329-5243
  • Fax:
Mailing address:
  • Phone: 352-484-4081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA29931
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: