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General NPI Number Information
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NPI Number | 1245553254
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Entity Type | Individual
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Provider Name | LINDA K SHAMBLIN PTA
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Gender | Female
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Dates
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Enumeration Date | 03/04/2010
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Last Update Date | 03/04/2010
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Provider Practice Location Address
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Address Line | 17848 456TH AVE
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City | CASTLEWOOD
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State | SD
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Zip | 57223-5212
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Country | US
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Telephone | 605-376-0690
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Fax |
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Provider Business Mailing Address
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Address Line | 17848 456TH AVE
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City | CASTLEWOOD
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State | SD
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Zip | 57223-5212
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Country | US
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Telephone | 605-376-0690
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1973
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License Number State | AR
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