Healthcare Provider Details

I. General information

NPI: 1033426812
Provider Name (Legal Business Name): SHANELLE NATALIE BALFOUR P. T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 BROUGHTON ST
ORANGEBURG SC
29115-4867
US

IV. Provider business mailing address

154 LOWER CHEROKEE RD
NEESES SC
29107-9546
US

V. Phone/Fax

Practice location:
  • Phone: 803-534-4050
  • Fax: 803-534-0408
Mailing address:
  • Phone: 904-392-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6055
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3598
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: