MEDICARE: SHAWN EDWARD HUMPHRIES MPT

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	5534	GA

General Provider Information

NPI Number	:	1609873454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN EDWARD HUMPHRIES MPT

Provider Business Mailing Address
First Line	:	8052 ADELAIDE DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-8031
Country	:	US
Telephone Number	:	706-329-5108
Fax Number	:

Provider Business Practice Location Address
First Line	:	252 STRICKLAND PASTURE RD
Second Line	:
City	:	JACKSON
State	:	GA
Zip	:	30233-4019
Country	:	US
Telephone Number	:	706-329-5108
Fax Number	:

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	05/26/2025

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