Healthcare Provider Details

I. General information

NPI: 1730808494
Provider Name (Legal Business Name): SHELBY LAYNE CLARK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELBY L TIPTON DPT

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 HIGHWAY 165 STE 5
NORTH LITTLE ROCK AR
72117-9781
US

IV. Provider business mailing address

PO BOX 5718
KALISPELL MT
59903-5718
US

V. Phone/Fax

Practice location:
  • Phone: 501-945-0200
  • Fax: 501-945-0245
Mailing address:
  • Phone: 406-756-0134
  • Fax: 406-309-2579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1367761
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1367761
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: