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General NPI Number Information
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NPI Number | 1033426812
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Entity Type | Individual
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Provider Name | SHANELLE NATALIE BALFOUR P. T.
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Gender | Female
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Dates
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Enumeration Date | 09/01/2010
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Last Update Date | 09/01/2010
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Provider Practice Location Address
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Address Line | 1620 BROUGHTON ST
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City | ORANGEBURG
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State | SC
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Zip | 29115-4867
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Country | US
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Telephone | 803-534-4050
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Fax | 803-534-0408
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Provider Business Mailing Address
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Address Line | 154 LOWER CHEROKEE RD
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City | NEESES
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State | SC
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Zip | 29107-9546
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Country | US
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Telephone | 904-392-1150
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 6055
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 3598
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License Number State | SC
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