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General NPI Number Information
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NPI Number | 1891092722
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Entity Type | Individual
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Provider Name | SHANNA A JIMERSON PT
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Gender | Female
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Dates
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Enumeration Date | 02/11/2011
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 1720A MEDICAL PARK DR STE 210
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City | BILOXI
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State | MS
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Zip | 39532-2122
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Country | US
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Telephone | 228-230-2663
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Fax |
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Provider Business Mailing Address
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Address Line | 6300 E LAKE BLVD STE 301
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City | VANCLEAVE
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State | MS
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Zip | 39565-6771
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Country | US
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Telephone | 228-203-2663
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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 | PT3331
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTH6346
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT6112
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License Number State | MS
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