MEDICARE: MRS. SHELLEY CELESTE D.P.T

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	2251P0200X	Pediatric Physical Therapist	2363	NV

General Provider Information

NPI Number	:	1841527827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHELLEY CELESTE D.P.T

Provider Business Mailing Address
First Line	:	3555 W RENO AVE STE F
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1609
Country	:	US
Telephone Number	:	702-262-0037
Fax Number	:	702-262-0252

Provider Business Practice Location Address
First Line	:	3555 W RENO AVE STE F
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1609
Country	:	US
Telephone Number	:	702-262-0037
Fax Number	:	702-262-0252

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

Provider Enumeration Date	:	11/11/2009
Last Update Date	:	11/11/2009

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