| Doctor Name: | MR. SHANNON BRANTLEY |
| NPI Number: | 1609081942 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | P.T, A.T.C. |
| License Number: | PT 007647 |
| Business Practice Address: | 101 Harris Industrial Blvd Vidalia, GA - 304748845 |
| Business Phone Number: | 9122772044 |
| Business Fax Number: | |
| Mailing Address: | Po Box 404, ADRIAN |
| State: | GA |
| Postal Code: | 310020404 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 05/11/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT 007647 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | GA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |