Provider Demographics
NPI:1073158945
Name:DILLANE, SHAYNA L (DPT)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:L
Last Name:DILLANE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SHAYNA
Other - Middle Name:L
Other - Last Name:ZOLLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-695-6071
Mailing Address - Fax:843-569-5879
Practice Address - Street 1:2500 ELMS CENTER RD STE B
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9844
Practice Address - Country:US
Practice Address - Phone:843-203-5051
Practice Address - Fax:843-806-2941
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9973225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH4106Medicaid