Provider Demographics
NPI:1417094095
Name:BELL, SHANA LYNN (LPTA)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:LYNN
Last Name:BELL
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:LYNN
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPTA
Mailing Address - Street 1:5 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MS
Mailing Address - Zip Code:38827-9201
Mailing Address - Country:US
Mailing Address - Phone:662-416-1049
Mailing Address - Fax:662-284-9866
Practice Address - Street 1:127 PRATT DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6026
Practice Address - Country:US
Practice Address - Phone:662-284-9838
Practice Address - Fax:662-284-9866
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA3102174400000X, 225200000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No174400000XOther Service ProvidersSpecialist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1487911269Medicaid