Provider Demographics
NPI:1982307591
Name:MORRIS, SHANE (PTA, BS)
Entity type:Individual
Prefix:MR
First Name:SHANE
Middle Name:
Last Name:MORRIS
Suffix:
Gender:M
Credentials:PTA, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5721 NW 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34482-2735
Mailing Address - Country:US
Mailing Address - Phone:352-484-4081
Mailing Address - Fax:
Practice Address - Street 1:3845 SE LAKE WEIR AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34480-9153
Practice Address - Country:US
Practice Address - Phone:352-329-5243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA29931225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant