Most Relevant Information
Provider Data
| NPI Number: | 1003404583 |
| Provider Name: | SHANNON BAKER EASINGWOOD PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | 4530 |
Most Important Dates
| Enumeration Date: | 01/09/2021 |
| Last Updated: | 01/09/2021 |
Provider Practice Location
101 BRIGHTWATER DR
MYRTLE BEACH
SC
295798275
Practice Location Phone/Fax
| Phone: | 8439038300 |
| Fax: |
Provider Mailing Location
223 MAISON DR UNIT 8 BOX 32
MYRTLE BEACH
SC
29572
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |