Healthcare Provider Details

I. General information

NPI: 1396416616
Provider Name (Legal Business Name): WELLNESS ON WHEELS PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 COCHRAN ST
DANIEL ISLAND SC
29492-7577
US

IV. Provider business mailing address

933 COCHRAN ST
DANIEL ISLAND SC
29492-7577
US

V. Phone/Fax

Practice location:
  • Phone: 240-447-5226
  • Fax:
Mailing address:
  • Phone: 240-447-5226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLY LYNN SHANNON
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: DPT
Phone: 240-447-5226