Provider Demographics
NPI:1194211862
Name:MERCHANT, SHANA BRITT (LPTA)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:BRITT
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6261 SW 24TH PL APT 101
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1143
Mailing Address - Country:US
Mailing Address - Phone:407-341-1775
Mailing Address - Fax:
Practice Address - Street 1:2685 EXECUTIVE PARK DR STE 4
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3651
Practice Address - Country:US
Practice Address - Phone:954-515-0892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA20269225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant