Provider Demographics
NPI:1053318295
Name:BIRNIE, SHELLEY (PT)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:
Last Name:BIRNIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 WANDO PARK BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7902
Mailing Address - Country:US
Mailing Address - Phone:843-884-1118
Mailing Address - Fax:843-884-2434
Practice Address - Street 1:498 WANDO PARK BLVD
Practice Address - Street 2:STE 200
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7902
Practice Address - Country:US
Practice Address - Phone:843-884-1118
Practice Address - Fax:843-884-2434
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1042225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3229888OtherAETNA
SC610458600OtherDOL
SC610458600OtherDOL