Most Relevant Information
Provider Data
| NPI Number: | 1003066853 |
| Provider Name: | SHANE MARLON PEDERSON P.T. |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | 1155757 |
Most Important Dates
| Enumeration Date: | 09/29/2008 |
| Last Updated: | 07/24/2013 |
Provider Practice Location
123 WEST MILE 3 ROAD
SUITE A-103
PALMHURST
TX
78573
Practice Location Phone/Fax
| Phone: | 9565859889 |
| Fax: | 9565859896 |
Provider Mailing Location
123 WEST MILE 3 ROAD
SUITE A-103
PALMHURST
TX
78573
Provider Mailing Phone/Fax
| Phone: | 9565859889 |
| Fax: | 9565859896 |