Provider Demographics
NPI:1629746995
Name:SHAPPLEY PEDIATRIC THERAPY LLC
Entity Type:Organization
Organization Name:SHAPPLEY PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOMMIE
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:SHAPPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:601-408-9546
Mailing Address - Street 1:PO BOX 16928
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-6928
Mailing Address - Country:US
Mailing Address - Phone:601-408-9105
Mailing Address - Fax:
Practice Address - Street 1:5 BOCAGE RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7804
Practice Address - Country:US
Practice Address - Phone:601-408-9546
Practice Address - Fax:601-476-5289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy