MEDICARE: SHELLY BALES STEPHENS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5722	TN

General Provider Information

NPI Number	:	1225076573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY BALES STEPHENS PT

Provider Business Mailing Address
First Line	:	PO BOX 306393
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37230-6393
Country	:	US
Telephone Number	:	615-373-1350
Fax Number	:	615-373-7116

Provider Business Practice Location Address
First Line	:	502 N MARKET ST STE 102
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37405-4438
Country	:	US
Telephone Number	:	423-634-1922
Fax Number	:	423-634-1924

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	06/29/2020

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