Healthcare Provider Details

I. General information

NPI: 1497561542
Provider Name (Legal Business Name): SHELBY TABLERIOU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 E MAIN ST STE C
MOUNTAIN VIEW AR
72560-4007
US

IV. Provider business mailing address

1103 E MAIN ST STE C
MOUNTAIN VIEW AR
72560-4007
US

V. Phone/Fax

Practice location:
  • Phone: 877-683-2993
  • Fax: 866-922-9146
Mailing address:
  • Phone: 877-683-2993
  • Fax: 866-922-9146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4366
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: