Healthcare Provider Details

I. General information

NPI: 1164651501
Provider Name (Legal Business Name): SHANNON HOWLAND D.P,T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 CHANNEL RD
LAKE WYLIE SC
29710-6102
US

IV. Provider business mailing address

1377 MOTOR PKWY STE 307
ISLANDIA NY
11749-5258
US

V. Phone/Fax

Practice location:
  • Phone: 803-746-7800
  • Fax:
Mailing address:
  • Phone: 631-580-5200
  • Fax: 631-580-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number7832
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: