MEDICARE: SHANNON B BERRIAN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	3916	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3916	OTHER	SC	LICENSE

General Provider Information

NPI Number	:	1417098039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON B BERRIAN PT

Provider Business Mailing Address
First Line	:	PO BOX 6069
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29171-6069
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 W MAIN ST STE 205
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-2500
Country	:	US
Telephone Number	:	803-358-6115
Fax Number	:	803-358-6117

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	10/13/2020

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Directions to “ SHANNON B BERRIAN PT” Practice Location

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