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General NPI Number Information
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NPI Number | 1629746995
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Entity Type | Organization
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Legal Business Name | SHAPPLEY PEDIATRIC THERAPY LLC
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Dates
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Enumeration Date | 09/01/2021
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 5 BOCAGE RD
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City | HATTIESBURG
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State | MS
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Zip | 39402-7804
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Country | US
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Telephone | 601-408-9546
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Fax | 601-476-5289
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Provider Business Mailing Address
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Address Line | PO BOX 16928
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City | HATTIESBURG
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State | MS
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Zip | 39404-6928
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Country | US
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Telephone | 601-408-9105
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TOMMIE JANE SHAPPLEY
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Credential | PT
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Telephone | 601-408-9546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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