Healthcare Provider Details

I. General information

NPI: 1417094095
Provider Name (Legal Business Name): SHANA LYNN BELL LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANA LYNN GRAHAM LPTA

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 PRATT DR
CORINTH MS
38834-6026
US

IV. Provider business mailing address

5 NORTHSIDE DR
BELMONT MS
38827-9201
US

V. Phone/Fax

Practice location:
  • Phone: 662-284-9838
  • Fax: 662-284-9866
Mailing address:
  • Phone: 662-416-1049
  • Fax: 662-284-9866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPTA3102
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA3102
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: