Provider Demographics
NPI:1740457191
Name:BARBER, SHELLY LAIN (MPT)
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:LAIN
Last Name:BARBER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 STONE POND WAY
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-5746
Mailing Address - Country:US
Mailing Address - Phone:864-256-7010
Mailing Address - Fax:
Practice Address - Street 1:245 STONE POND WAY
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-5746
Practice Address - Country:US
Practice Address - Phone:864-256-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC48152251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1494Medicaid