Basic Information
| Provider Information | |||||||||
| NPI: | 1063980100 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | SHELBY | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 SHUFORD RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287227406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288940277 | ||||||||
| FaxNumber: | 8288940278 | ||||||||
| Practice Location | |||||||||
| Address1: | 13021 ASHEVILLE HWY | ||||||||
| Address2: | |||||||||
| City: | INMAN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293497687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644161289 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2018 | ||||||||
| LastUpdateDate: | 08/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | P21175 | NC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 9454 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.