Provider Demographics
NPI:1891007522
Name:WILLIAMSON SHAPPLEY, TOMMIE J
Entity Type:Individual
Prefix:
First Name:TOMMIE
Middle Name:J
Last Name:WILLIAMSON SHAPPLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TJ
Other - Middle Name:
Other - Last Name:SHAPPLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:48 PLEASANT POND LOOP
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8253
Mailing Address - Country:US
Mailing Address - Phone:601-408-9546
Mailing Address - Fax:
Practice Address - Street 1:48 PLEASANT POND LOOP
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8253
Practice Address - Country:US
Practice Address - Phone:601-408-9546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1986225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist